Subscribe to RSS

DOI: 10.1055/a-1913-7900
Clinical Characteristics and Associated Factors of Colonic Polyps in Acromegaly
Funding This work was supported by grants from the Clinical Research Project of Army Medical University (2019XLC2009 and 2018XLC3049) and the Chongqing Natural Science Foundation (Outstanding Youth Foundation, No. CSTC2020JCYJ-JQX0017).
Abstract
Purpose To investigate the clinical characteristics and associated factors of colonic polyps in patients with acromegaly.
Methods Clinical characteristics and colonoscopy findings of 86 acromegaly patients who received treatment were retrospectively reviewed, and colonoscopy findings and the correlation with growth hormone (GH)-secreting pituitary adenoma (GHPA) volume and hormonal/metabolic levels were analyzed.
Results The prevalence of colonic polyps in acromegaly patients was 40.7% and increased significantly with advanced age, especially in those ≥50 years. Multiple polyps (62.8%) and colonic polyps in the left colon (54.2%) were detected more frequently. Compared to acromegaly patients without polyps, those with polyps displayed higher insulin-like growth factor-1 × upper limit of normal (IGF-1×ULN) levels (P=0.03). IGF-1 levels and GHPA volumes in patients with polyps showed increasing trends, although the differences were not significant. GH levels were higher in patients with polyps of diameter ≤5 mm than those with polyps of diameter >5 mm (P=0.031). The univariate and multivariate logistic regression analysis revealed that GHPA volumes (OR: 1.09, 95% CI: 1.01–1.20; P=0.039) and IGF-1×ULN Q2 levels (OR: 6.51, 95% CI: 1.20–44.60; P=0.038) were independent factors for predicting the risk of colonic polyp occurrence in acromegaly patients. A nomogram was prepared to evaluate the risk of colonic polyps in acromegaly patients.
Conclusion The acromegalic patients are a population with a high prevalence of colonic polyps. GHPA volumes and IGF-1×ULN levels may be predictors of colonic polyp occurrence.
Key words
acromegaly - colonic polyps - growth hormone (GH) - colonoscopy - insulin-like growth factor-1(IGF-1)# These authors contributed equally: Guiliang Peng, Xing Li.
Publication History
Received: 27 March 2022
Received: 14 June 2022
Accepted: 13 July 2022
Article published online:
08 September 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am 2008; 37: 101-122 viii DOI: 10.1016/j.ecl.2007.10.002.
- 2 Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119: 3189-3202 DOI: 10.1172/jci39375.
- 3 Sherlock M, Ayuk J, Tomlinson JW. et al. Mortality in patients with pituitary disease. Endocr Rev 2010; 31: 301-342 DOI: 10.1210/er.2009-0033.
- 4 Ayuk J, Clayton RN, Holder G. et al. Growth hormone and pituitary radiotherapy, but not serum insulin-like growth factor-I concentrations, predict excess mortality in patients with acromegaly. J Clin Endocrinol Metab 2004; 89: 1613-1617 DOI: 10.1210/jc.2003-031584.
- 5 Colao A, Ferone D, Marzullo P. et al. Systemic complications of acromegaly: Epidemiology, pathogenesis, and management. Endocr Rev 2004; 25: 102-152 DOI: 10.1210/er.2002-0022.
- 6 Gadelha MR, Kasuki L, Lim DST. et al. Systemic complications of acromegaly and the impact of the current treatment landscape: An update. Endocr Rev 2019; 40: 268-332 DOI: 10.1210/er.2018-00115.
- 7 Terzolo M, Reimondo G, Gasperi M. et al. Colonoscopic screening and follow-up in patients with acromegaly: A multicenter study in Italy. J Clin Endocrinol Metab 2005; 90: 84-90 DOI: 10.1210/jc.2004-0240.
- 8 Colao A, Pivonello R, Auriemma RS. et al. The association of fasting insulin concentrations and colonic neoplasms in acromegaly: A colonoscopy-based study in 210 patients. J Clin Endocrinol Metab 2007; 92: 3854-3860 DOI: 10.1210/jc.2006-2551.
- 9 Bogazzi F, Cosci C, Sardella C. et al. Identification of acromegalic patients at risk of developing colonic adenomas. J Clin Endocrinol Metab 2006; 91: 1351-1356 DOI: 10.1210/jc.2005-2500.
- 10 Dekker E, Tanis PJ, Vleugels JLA. et al. Colorectal cancer. Lancet 2019; 394: 1467-1480 DOI: 10.1016/s0140-6736(19)32319-0.
- 11 Terzolo M, Puglisi S, Reimondo G. et al. Thyroid and colorectal cancer screening in acromegaly patients: Should it be different from that in the general population?. Eur J Endocrinol 2020; 183: D1-d13 DOI: 10.1530/eje-19-1009.
- 12 Terzolo M, Reimondo G, Berchialla P. et al. Acromegaly is associated with increased cancer risk: A survey in Italy. Endocr Relat Cancer 2017; 24: 495-504 DOI: 10.1530/erc-16-0553.
- 13 Petroff D, Tönjes A, Grussendorf M. et al. The incidence of cancer among acromegaly patients: Results From the German Acromegaly Registry. J Clin Endocrinol Metab 2015; 100: 3894-3902 DOI: 10.1210/jc.2015-2372.
- 14 Katznelson L, Laws ER, Melmed S. et al. Acromegaly: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99: 3933-3951 DOI: 10.1210/jc.2014-2700.
- 15 Colao A, Grasso LFS, Giustina A. et al. Acromegaly. Nat Rev Dis Primers 2019; 5: 20 DOI: 10.1038/s41572-019-0071-6.
- 16 Potorac I, Petrossians P, Daly AF. et al. T2-weighted MRI signal predicts hormone and tumor responses to somatostatin analogs in acromegaly. Endocr Relat Cancer 2016; 23: 871-881 DOI: 10.1530/erc-16-0356.
- 17 Hong W, Dong L, Stock S. et al. Prevalence and characteristics of colonic adenoma in mainland China. Cancer Manag Res 2018; 10: 2743-2755 DOI: 10.2147/cmar.S166186.
- 18 Cai B, Liu Z, Xu Y. et al. Adenoma detection rate in 41,010 patients from Southwest China. Oncol Lett 2015; 9: 2073-2077 DOI: 10.3892/ol.2015.3005.
- 19 Chen S, Sun K, Chao K. et al. Detection rate and proximal shift tendency of adenomas and serrated polyps: A retrospective study of 62,560 colonoscopies. Int J Colorectal Dis 2018; 33: 131-139 DOI: 10.1007/s00384-017-2951-0.
- 20 Pan J, Cen L, Xu L. et al. Prevalence and risk factors for colorectal polyps in a Chinese population: A retrospective study. Sci Rep 2020; 10: 6974 DOI: 10.1038/s41598-020-63827-6.
- 21 Popovic V, Damjanovic S, Micic D. et al. Increased incidence of neoplasia in patients with pituitary adenomas. The Pituitary Study Group. Clin Endocrinol (Oxf) 1998; 49: 441-445 DOI: 10.1046/j.1365-2265.1998.00536.x.
- 22 Maione L, Brue T, Beckers A. et al. Changes in the management and comorbidities of acromegaly over three decades: The French Acromegaly Registry. Eur J Endocrinol 2017; 176: 645-655 DOI: 10.1530/eje-16-1064.
- 23 Petrossians P, Daly AF, Natchev E. et al. Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Endocr Relat Cancer 2017; 24: 505-518 DOI: 10.1530/erc-17-0253.
- 24 Parolin M, Dassie F, Russo L. et al. Guidelines versus real life practice: The case of colonoscopy in acromegaly. Pituitary 2018; 21: 16-24 DOI: 10.1007/s11102-017-0841-7.
- 25 Ochiai Y, Inoshita N, Iizuka T. et al. Clinicopathological features of colorectal polyps and risk of colorectal cancer in acromegaly. Eur J Endocrinol 2020; 182: 313-318 DOI: 10.1530/EJE-19-0813.
- 26 Gonzalez B, Vargas G, Mendoza V. et al. The prevalence of colonic polyps in patients with acromegaly: A case-control, nested in a cohort colonoscopic study. Endocr Pract 2017; 23: 594-599 DOI: 10.4158/ep161724.Or.
- 27 Battistone MF, Miragaya K, Rogozinski A. et al. Increased risk of preneoplastic colonic lesions and colorectal carcinoma in acromegaly: Multicenter case-control study. Pituitary 2021; 24: 96-103 DOI: 10.1007/s11102-020-01090-8.
- 28 Liu HH, Wu MC, Peng Y. et al. Prevalence of advanced colonic polyps in asymptomatic Chinese. World J Gastroenterol 2005; 11: 4731-4734 DOI: 10.3748/wjg.v11.i30.4731.
- 29 Delhougne B, Deneux C, Abs R. et al. The prevalence of colonic polyps in acromegaly: A colonoscopic and pathological study in 103 patients. J Clin Endocrinol Metab 1995; 80: 3223-3226 DOI: 10.1210/jcem.80.11.7593429.
- 30 Renehan AG, Bhaskar P, Painter JE. et al. The prevalence and characteristics of colorectal neoplasia in acromegaly. J Clin Endocrinol Metab 2000; 85: 3417-3424 DOI: 10.1210/jcem.85.9.6775.
- 31 Lois K, Bukowczan J, Perros P. et al. The role of colonoscopic screening in acromegaly revisited: Review of current literature and practice guidelines. Pituitary 2015; 18: 568-574 DOI: 10.1007/s11102-014-0586-5.
- 32 Qaseem A, Denberg TD, Hopkins RH. et al. Screening for colorectal cancer: A guidance statement from the American College of Physicians. Ann Intern Med 2012; 156: 378-386 DOI: 10.7326/0003-4819-156-5-201203060-00010.
- 33 Qaseem A, Crandall CJ, Mustafa RA. et al. Screening for colorectal cancer in asymptomatic average-risk adults: A guidance statement from the American College of Physicians. Ann Intern Med 2019; 171: 643-654 DOI: 10.7326/m19-0642.
- 34 Cairns SR, Scholefield JH, Steele RJ. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002. Gut 2010; 59: 666-689 DOI: 10.1136/gut.2009.179804.
- 35 Dworakowska D, Gueorguiev M, Kelly P. et al. Repeated colonoscopic screening of patients with acromegaly: 15-year experience identifies those at risk of new colonic neoplasia and allows for effective screening guidelines. Eur J Endocrinol 2010; 163: 21-28 DOI: 10.1530/eje-09-1080.
- 36 Ezzat S, Serri O, Chik CL. et al. Canadian consensus guidelines for the diagnosis and management of acromegaly. Clin Invest Med 2006; 29: 29-39
- 37 Katznelson L, Atkinson JL, Cook DM. et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocr Pract 2011; 17 Suppl 4 1-44 DOI: 10.4158/ep.17.s4.1.
- 38 Melmed S, Casanueva FF, Klibanski A. et al. A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 2013; 16: 294-302 DOI: 10.1007/s11102-012-0420-x.
- 39 Wolf AMD, Fontham ETH, Church TR. et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018; 68: 250-281 DOI: 10.3322/caac.21457.
- 40 Jenkins PJ, Fairclough PD. Screening guidelines for colorectal cancer and polyps in patients with acromegaly. Gut 2002; 51 Suppl 5 V13-V14 DOI: 10.1136/gut.51.suppl_5.v13.
- 41 Iwamuro M, Yasuda M, Hasegawa K. et al. Colonoscopy examination requires a longer time in patients with acromegaly than in other individuals. Endocr J 2018; 65: 151-157 DOI: 10.1507/endocrj.EJ17-0322.
- 42 Matano Y, Okada T, Suzuki A. et al. Risk of colorectal neoplasm in patients with acromegaly and its relationship with serum growth hormone levels. Am J Gastroenterol 2005; 100: 1154-1160 DOI: 10.1111/j.1572-0241.2005.40808.x.
- 43 Yamamoto M, Fukuoka H, Iguchi G. et al. The prevalence and associated factors of colorectal neoplasms in acromegaly: A single center based study. Pituitary 2015; 18: 343-351 DOI: 10.1007/s11102-014-0580-y.