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      Incidence rate and risk factors of early repolarization in patients with growth hormone-secreting pituitary adenoma: a cohort study

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          Abstract

          Purpose

          To investigate the incidence and risk factors for early repolarization (ER) in patients with growth hormone (GH)-secreting pituitary adenomas.

          Methods

          From August 2014 to August 2016, patients with GH-secreting pituitary adenomas and non-functioning pituitary adenomas admitted to the First Affiliated Hospital, Sun Yat-sen University, were prospectively enrolled. Logistic regression analysis was used to investigate risk factors for ER development.

          Results

          A total of 118 patients with GH-secreting pituitary adenomas (41 with concomitant ER) and 103 patients with non-functioning pituitary adenomas were included. Compared with the non-functioning adenoma group GH and IGF-1 levels, left ventricular mass index (LVMI), and incidence of ER were significantly higher in the GH-secreting pituitary adenoma group (all P<0.05). LVMI was an independent risk factor for ER. Bivariate correlation analysis showed that course of disease, GH, IGF-1, and diabetes were correlated with LVMI. Course of disease and IGF-1 were directly correlated with LVMI. Two-year follow-up of patients who underwent transsphenoidal resection showed that incidence of ER was significantly decreased in patients with normal GH and IGF-1 levels.

          Conclusion

          Compared with non-functioning pituitary adenoma patients, patients with GH-secreting pituitary adenomas have a significantly higher incidence of ER. Elevation of serum GH and IGF-1 had positive correlations with cardiac muscle cell hypertrophy and increased LVMI.

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          Most cited references 25

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          Medical progress: Acromegaly.

           Shlomo Melmed (2006)
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            Systemic complications of acromegaly: epidemiology, pathogenesis, and management.

            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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              Long-term outcome associated with early repolarization on electrocardiography.

              Early repolarization, which is characterized by an elevation of the QRS-ST junction (J point) in leads other than V(1) through V(3) on 12-lead electrocardiography, has been associated with vulnerability to ventricular fibrillation, but little is known about the prognostic significance of this pattern in the general population. We assessed the prevalence and prognostic significance of early repolarization on 12-lead electrocardiography in a community-based general population of 10,864 middle-aged subjects (mean [+/-SD] age, 44+/-8 years). The primary end point was death from cardiac causes, and secondary end points were death from any cause and death from arrhythmia during a mean follow-up of 30+/-11 years. Early repolarization was stratified according to the degree of J-point elevation (> or = 0.1 mV or > 0.2 mV) in either inferior or lateral leads. The early-repolarization pattern of 0.1 mV or more was present in 630 subjects (5.8%): 384 (3.5%) in inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). J-point elevation of at least 0.1 mV in inferior leads was associated with an increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval [CI], 1.04 to 1.59; P=0.03); 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) and from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P=0.01). Other electrocardiographic risk markers, such as a prolonged QT interval corrected for heart rate (P=0.03) and left ventricular hypertrophy (P=0.004), were weaker predictors of the primary end point. An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects. 2009 Massachusetts Medical Society
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2019
                28 December 2018
                : 15
                : 65-72
                Affiliations
                [1 ]Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, SunYat-sen University, Guangzhou, People’s Republic of China, wanghaij@ 123456mail.sysu.edu.cn ; 25198960@ 123456qq.com
                [2 ]Department of Neurosurgery, The First Affiliated Hospital, Jinan University, Guangzhou, People’s Republic of China
                [3 ]Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People’s Republic of China
                [4 ]Department of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
                [5 ]Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
                Author notes
                Correspondence: Haijun Wang; Zhigang Mao, Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou 510080, People’s Republic of China, Tel +86 20 2882 3388, Email wanghaij@ 123456mail.sysu.edu.cn ; 25198960@ 123456qq.com
                [*]

                These authors contributed equally to this work

                Article
                tcrm-15-065
                10.2147/TCRM.S185929
                6314049
                © 2019 Chen et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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