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      Evaluation of the thyroid characteristics of patients with growth hormone-secreting adenomas

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          Abstract

          Background

          Acromegaly is highly associated with thyroid disorders. However, the clinical characteristics of thyroid nodules in individuals with acromegaly who present with thyroid diseases have not been completely elucidated.

          Methods

          Overall, 134 consecutive participants with growth hormone (GH)-secreting adenoma ( n = 67) and non-functioning (NF) pituitary adenoma (n = 67) were recruited from the outpatient and inpatient patient department of The First Affiliated Hospital, Jinan University from August 2015 to August 2017. Thyroid ultrasonography was performed using an ultrasound system. The cytopathological results of fine-needle aspiration biopsy were analyzed by a pathologist according to the Bethesda system. Twenty-one patients with GH-secreting adenoma and thyroid disease underwent transsphenoidal pituitary adenoma resection and were followed up for 1 year.

          Results

          The prevalence of thyroid disease increased in the GH-secreting adenoma group compared with that in the NF pituitary adenoma group. The number of hypoechoic, isoechogenic, heterogeneous, and vascular thyroid nodules increased in patients with GH-secreting adenoma plus thyroid disease compared with that in patients with NF pituitary adenoma plus thyroid disease. Finally, we found significant decreases in the morphology of solid nodules and significant increases in the morphology of cystic nodules after surgery compared with those before surgery in the cured group. Moreover, the numbers of heterogeneous and vascular thyroid nodules decreased significantly after surgery compared with those before surgery in the cured group. However, the characteristics of the thyroid nodules did not change after surgery compared with those before surgery in the non-cured group.

          Conclusions

          The numbers of hypoechoic, isoechoic, heterogeneous, and vascular thyroid nodules increased in patients with GH-secreting adenomas. In these patients, surgery resulted in significant changes from solid to cystic nodules and also reduced the numbers of heterogeneous and vascular thyroid nodules.

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          Most cited references25

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          Systemic complications of acromegaly: epidemiology, pathogenesis, and management.

          Annamaria Colao, Diego Ferone, Paolo Marzullo … (2004)
          This review focuses on the systemic complications of acromegaly. Mortality in this disease is increased mostly because of cardiovascular and respiratory diseases, although currently neoplastic complications have been questioned as a relevant cause of increased risk of death. Biventricular hypertrophy, occurring independently of hypertension and metabolic complications, is the most frequent cardiac complication. Diastolic and systolic dysfunction develops along with disease duration; and other cardiac disorders, such as arrhythmias, valve disease, hypertension, atherosclerosis, and endothelial dysfunction, are also common in acromegaly. Control of acromegaly by surgery or pharmacotherapy, especially somatostatin analogs, improves cardiovascular morbidity. Respiratory disorders, sleep apnea, and ventilatory dysfunction are also important contributors in increasing mortality and are advantageously benefitted by controlling GH and IGF-I hypersecretion. An increased risk of colonic polyps, which more frequently recur in patients not controlled after treatment, has been reported by several independent investigations, although malignancies in other organs have also been described, but less convincingly than at the gastrointestinal level. Finally, the most important cause of morbidity and functional disability of the disease is arthropathy, which can be reversed at an initial stage, but not if the disease is left untreated for several years.
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            Acromegaly and cancer risk: a cohort study in Sweden and Denmark.

            D Baris, G Gridley, E. Ron … (2002)
            Several studies have suggested that patients with acromegaly have an increased risk of benign and malignant neoplasms, especially of the colon. To further investigate this relationship we evaluated cancer risk in population-based cohorts of acromegaly patients in Sweden and Denmark. Nationwide registry-based cohorts of patients hospitalized for acromegaly (Denmark 1977-1993; Sweden 1965-1993) were linked to tumor registry data for up to 15-28 years of follow-up, respectively. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated to estimate cancer risk among 1634 patients with acromegaly. The patterns of cancer risk in Sweden and Denmark were similar. After excluding the first year of follow-up, 177 patients with acromegaly had a diagnosis of cancer compared with an expected number of 116.5 (SIR = 1.5. 95% CI = 1.3-1.8). Increased risks were found for digestive system cancers (SIR = 2.1, 95% CI = 1.62.7), notably of the small intestine (SIR = 6.0, 95% CI = 1.2-17.4), colon (SIR = 2.6, 95% CI = 1.6-3.8), and rectum (SIR = 2.5, 95% CI= 1.3-4.2). Risks were also elevated for cancers of the brain (SIR = 2.7, 95% CI= 1.2-5.0). thyroid (SIR = 3.7, 95% CI = 1.8-10.9), kidney (SIR = 3.2, 95% CI = 1.6-5.5), and bone (SIR= 13.8, 95% CI= 1.7-50.0). The increased risk for several cancer sites among acromegaly patients may be due to the elevated proliferative and anti-apoptotic activity associated with increased circulating levels of insulin-like growth factor-1 (IGF-1). Pituitary irradiation given to some patients may have contributed to the excess risks of brain tumors and thyroid cancer. Our findings indicate the need for close medical surveillance of patients with acromegaly, and further studies of the IGF-I system in the etiology of various cancers.
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              Thyroid cancer is the most common cancer associated with acromegaly.

              Bennur Esen Gullu, Ozlem Celik, Nurperi Gazioglu … (2010)
              The aim of the study was to screen the malignancy in an acromegalic patient group and to determine whether there was any increased risk and the incidence of malignancy and its association with disease characteristics such as duration of disease, latency in diagnosis, and GH and IGF-1 levels. One hundred-five (65 female, 40 male) patients with acromegaly followed and treated at Cerrahpasa Medical School, Endocrinology and Metabolism outpatient clinic between 1983 and 2007 were included in this study. The patients were screened with colonoscopy, mammography, and thyroid and prostate ultrasonography (US). Malignancy was detected in 16 (15%) patients. Thyroid cancer was found in 5 patients (4.7%), breast cancer in 3 (2.8%), colon cancer in 2 (1.9%), lung cancer in 2 (1.9%), cervix cancer in 1 (0.9%), myelodysplastic syndrome (MDS) in 1 (0.9%), cholangiocarcinoma in 1 (0.9%), and multiple endocrine neoplasm (MEN) type 1 in 1 patient (0.9%). Cancer was more common in the male patients (P = 0.046) and high levels of GH increased the risk of cancer development (P = 0.046). In this series, the most commonly detected cancer types were thyroid followed by breast and colon cancers. Although high levels of initial GH seemed to increase the risk of cancer development in acromegalic patients, age, gender, age at the time of diagnosis, duration of disease, and initial IGF-I levels were not associated with cancer development.
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                Author and article information

                Contributors
                Zhiyong Chen:
                ORCID: http://orcid.org/0000-0002-8932-329X
                chenzhy43@outlook.com
                Xiaodong Wang: 13922795840@163.com
                Journal
                Journal ID (nlm-ta): BMC Endocr Disord
                Journal ID (iso-abbrev): BMC Endocr Disord
                Title: BMC Endocrine Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6823
                Publication date (Electronic): 2 September 2019
                Publication date PMC-release: 2 September 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 94
                Affiliations
                [1 ]ISNI 0000 0004 1760 3828, GRID grid.412601.0, Department of Neurosurgery, , The First Affiliated Hospital, Jinan University, ; No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province 510630 People’s Republic of China
                [2 ]GRID grid.412615.5, Department of Medical Ultrasound, , First Affiliated Hospital, Sun Yat-Sen University, ; Guangzhou, 510632 China
                [3 ]ISNI 0000 0001 2360 039X, GRID grid.12981.33, Department of cardiology, , The First Affiliated Hospital, SunYat-sen University, ; Guangzhou, 510632 China
                [4 ]GRID grid.412615.5, Department of laboratory medicine, , The first affiliated hospital, Sun Yat-sen university, ; Guangzhou, 510632 China
                [5 ]ISNI 0000 0001 2301 6433, GRID grid.440718.e, Asset Management Division, , Guangdong University of Foreign Studies, ; Guangzhou, 510420 China
                [6 ]GRID grid.268415.c, Department of Neurosurgery, , The Affiliated Hospital of Yangzhou University, ; Yangzhou, 225012 China
                Author information
                http://orcid.org/0000-0002-8932-329X
                Article
                Publisher ID: 424
                DOI: 10.1186/s12902-019-0424-x
                PMC ID: 6720980
                PubMed ID: 31477080
                SO-VID: 264cb5cf-5d39-4091-afa3-419fdf448846
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 7 May 2019
                Date accepted : 26 August 2019
                Funding
                Funded by: National Natural Scientific Foundation of China
                Award ID: 81600260
                Award Recipient :
                Funded by: Guangdong Natural Science Foundation
                Award ID: 2016A030313210
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: thyroid disease,growth hormone secreting adenomas,thyroid nodules,ultrasound
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: thyroid disease, growth hormone secreting adenomas, thyroid nodules, ultrasound

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