Diagnóstico de acromegalia

  • Catalina Rúa Marín Fundación Hospitalaria San Vicente de Paúl
  • Guillermo Latorre Sierra Universidad de Antioquia
  • Germán Campuzano Maya Laboratorio Clínico Hematológico, Universidad de Antioquia
Palabras clave: acromegalia, hormona del crecimiento, epidemiología, fisiopatología, clínica, diagnóstico, IGF-1, somatomedina C.

Resumen

La acromegalia como entidad clínica se ha reconocido desde la antigüedad, es considerada una enfermedad de baja incidencia pero con grandes repercusiones en cuanto a morbilidad, mortalidad y enfermedades asociadas. En la actualidad sigue siendo un reto su diagnóstico debido a que los síntomas y signos considerados como patognomónicos son de aparición lenta y sutil, por lo que se requiere de una alta sospecha y experticia clínica en el personal de salud que se enfrenta al paciente con acromegalia, particularmente en  una  fase  temprana  de  la  enfermedad.  En el presente artículo se hace un recorrido por los pasos que se deben seguir para establecer el diagnóstico de acromegalia en un paciente sospechoso, haciendo especial énfasis en las mediciones hormonales requeridas.

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Biografía del autor/a

Catalina Rúa Marín, Fundación Hospitalaria San Vicente de Paúl

Médica especialista en Medicina Interna y Endocrinología Clínica y Metabolismo. Fundación Hospitalaria San Vicente de Paúl. Centro de Investigación Clínica. Medellín, Colombia.

Guillermo Latorre Sierra, Universidad de Antioquia

Médico especialista en Medicina Interna y Endocrinología. Profesor titular, Jefe de la Sección de Endocrinología y Metabolismo. Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.

Germán Campuzano Maya, Laboratorio Clínico Hematológico, Universidad de Antioquia

Médico especialista en Hematología y Patología Clínica. Docente, Ad Honorem, Facultad de Medicina, Universidad de Antioquia. Médico Director, Laboratorio Clínico Hematológico. Medellín, Colombia.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Referencias bibliográficas

Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119: 3189-3202. https://doi.org/10.1172/JCI39375

Epelbaum J. Intrahypothalamic neurohormonal interactions in the control of growth hormone secretion. In: Functional Anatomy of the Neuroendocrine Hypothalamus. Wiley, Chichester; pp. 54-68, 1992. https://doi.org/10.1002/9780470514283.ch5

Balthasar N, Mery PF, Magoulas CB, Mathers KE, Martin A. Mollard P, et al. Growth hormone-releasing Hormone (GHRH) neurons in GHRH-enhanced green fluorescent protein transgenic mice: a ventral hypothalamic network. Endocrinology 2003; 144: 2728- 2740. https://doi.org/10.1210/en.2003-0006

Melmed S. Medical progress: Acromegaly. N Engl J Med 2006; 355: 2558-2573. https://doi.org/10.1056/NEJMra062453

Lopera-Cañaveral MV, Campuzano-Maya G, Balthazar-González V, Alfaro-Velásquez JM. Estudio del paciente con talla baja. Medicina & Laboratorio 2009; 15: 511-531.

Walters TD, Griffiths AM. Mechanisms of growth impairment in pediatric Crohn's disease. Nat Rev Gastroenterol Hepatol 2009; 6: 513-523. https://doi.org/10.1038/nrgastro.2009.124

Ballerini MG, Ropelato MG. El receptor de la hormona de crecimiento humana (hGH) y la proteína de trans- porte de alta afinidad de la hGH. Revista Argentina de Endocrinología y Metabolismo 2008; 45: 28-46.

Vance ML. Acromegaly: a fascinating pituitary disorder. Introduction. Neurosurg Focus 2010; 29: Introduction. https://doi.org/10.3171/2010.10.FOCUS.Intro

Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary 1999; 2: 29-41. https://doi.org/10.1023/A:1009965803750

Schneider HJ, Sievers C, Saller B, Wittchen HU, Stalla GK. High prevalence of biochemical acromegaly in primary care patients with elevated IGF-1 levels. Clinical Endocrinology 2008; 69: 432-435. https://doi.org/10.1111/j.1365-2265.2008.03221.x

Bex M, Abs R, T'Sjoen G, Mockel J, Velkeniers B, Muermans K, et al. AcroBel--the Belgian registry on acromegaly: a survey of the 'real-life' outcome in 418 acromegalic subjects. European journal of endocrinology / European Federation of Endocrine Societies 2007; 157: 399-409. https://doi.org/10.1530/EJE-07-0358

Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clinical Endocrinology 1994; 41: 95-102. https://doi.org/10.1111/j.1365-2265.1994.tb03789.x

Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 2009; 94: 1509-1517. https://doi.org/10.1210/jc.2008-2421

Scacchi M, Cavagnini F. Acromegaly. Pituitary 2006; 9: 297-303. https://doi.org/10.1007/s11102-006-0409-4

Schulte HM, Oldfield EH, Allolio B, Katz DA, Berkman RA, Ali IU. Clonal composition of pituitary adenomas in patients with Cushing's disease: determination by X-chromosome inactivation analysis. J Clin Endocrinol Metab 1991; 73: 1302-1308. https://doi.org/10.1210/jcem-73-6-1302

Vallar L, Spada A, Giannattasio G. Altered Gs and adenylate cyclase activity in human GH-secreting pituitary adenomas. Nature 1987; 330: 566-568. https://doi.org/10.1038/330566a0

Asa SL, Ezzat S. The pathogenesis of pituitary tumors. Annu Rev Pathol 2009; 4: 97-126. https://doi.org/10.1146/annurev.pathol.4.110807.092259

Melmed S. Mechanisms for pituitary tumorigenesis: the plastic pituitary. J Clin Invest 2003; 112: 1603-1618. https://doi.org/10.1172/JCI20401

National Endocrine and Metabolic Diseases Information Service. Acromegaly. http://endocrine.niddk. nih.gov/pubs/acro/acro.aspx. Accesado el 10 de juni o de 2011.

Melmed S. Acromegaly. N Engl J Med 1990; 322: 966- 977. https://doi.org/10.1056/NEJM199004053221405

Stoffel-Wagner B, Springer W, Bidlingmaier F, Kling- muller D. A comparison of different methods for diagnosing acromegaly. Clinical endocrinology 1997; 46: 531-537. https://doi.org/10.1046/j.1365-2265.1997.1430983.x

Ritchie CM, Atkinson AB, Kennedy AL, Lyons AR, Gordon DS, Fannin T, et al. Ascertainment and natural history of treated acromegaly in Northern Ireland. The Ulster Medical Journal 1990; 59: 55-62.

Beauregard C, Truong U, Hardy J, Serri O. Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clinical Endocrinology 2003; 58: 86-91. https://doi.org/10.1046/j.1365-2265.2003.01679.x

Colao A, Marzullo P, Vallone G, Marino V, Annecchi- no M, Ferone D, et al. Reversibility of joint thickening in acromegalic patients: an ultrasonography study. J Clin Endocrinol Metab 1998; 83: 2121-2125. https://doi.org/10.1210/jcem.83.6.4865

Fieffe S, Morange I, Petrossians P, Chanson P, Roh- mer V, Cortet C, et al. Diabetes in acromegaly, prevalence, risk factors and evolution; data from the French acromegaly register. European J Endocrinol / European Federation of Endocrine Societies 2011. https://doi.org/10.1530/EJE-10-1050

Delhougne B, Deneux C, Abs R, Chanson P, Fierens H, Laurent-Puig P, 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. https://doi.org/10.1210/jcem.80.11.7593429

Terzolo M, Reimondo G, Gasperi M, Cozzi R, Pivo- nello R, Vitale G, et al. Colonoscopic screening and follow-up in patients with acromegaly: a multicenter study in Italy. J Clin Endocrinol Metab 2005; 90: 84- 90. https://doi.org/10.1210/jc.2004-0240

Renehan AG, Shalet SM. Acromegaly and colorectal cancer: risk assessment should be based on population-based studies. J Clin Endocrinol Metab 2002; 87:1909. https://doi.org/10.1210/jcem.87.4.8369

Dekkers OM, Biermasz NR, Pereira AM, Romijn JA, Vandenbroucke JP. Mortality in acromegaly: a metaanalysis. J Clin Endocrinol Metab 2008; 93: 61-67. https://doi.org/10.1210/jc.2007-1191

Orme S, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: a retrospective cohort study. J Clin Endocrinol Metab 1998; 83: 2730-2734. https://doi.org/10.1210/jc.83.8.2730

Bengtsson BA, Eden S, Ernest I, Oden A, Sjogren B. Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984. Acta Med Scandinavica Scandinavica 1988; 223: 327- 335. https://doi.org/10.1111/j.0954-6820.1988.tb15881.x

Alexander L, Appleton D, Hall R, Ross WM, Wilkin- son R. Epidemiology of acromegaly in the Newcastle region. Clinical Endocrinology 1980; 12: 71-79. https://doi.org/10.1111/j.1365-2265.1980.tb03135.x

Katznelson L, Atkinson JLD, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly-2011 update. Endocr Pract. 2011; 17: 1-44. https://doi.org/10.4158/EP.17.4.636

Iranmanesh A, Grisso B, Veldhuis JD. Low basal and persistent pulsatile growth hormone secretion are revealed in normal and hyposomatotropic men studied with a new ultrasensitive chemiluminescence assay. J Clin Endocrinol Metab 1994; 78: 526-535. https://doi.org/10.1210/jcem.78.3.8126122

Chanson P, Salenave S, Kamenicky P, Cazabat L, Young J. Pituitary tumours: acromegaly. Best Pract & Research Clin Endocrinol Metab 2009; 23: 555-574. https://doi.org/10.1016/j.beem.2009.05.010

Clemmons DR, Van Wyk JJ, Ridgway EC, Kliman B, Kjellberg RN, Underwood LE. Evaluation of acromegaly by radioimmunoassay of somatomedin-C. N Engl J Med 1979; 301: 1138-1142.

https://doi.org/10.1056/NEJM197911223012102

Barkan AL, Beitins IZ, Kelch RP. Plasma insulin-like growth factor-I/somatomedin-C in acromegaly: correlation with the degree of growth hormone hypersecretion. J Clin Endocrinol Metab 1988, 67: 69-73. https://doi.org/10.1210/jcem-67-1-69

Cozzi R, Baldelli R, Colao AM, Lasio G, Zini M, Attanasio R. Ame Position Statement On Clinical Management Of Acromegaly. J Endocrinol Invest 2009; 32: 2-25.

Clemmons DR. Clinical utility of measurements of insulin-like growth factor 1. Nature Clin Practice Endocrinol Metab 2006; 2: 436-446. https://doi.org/10.1038/ncpendmet0244

Guitelman M, Radczuk G, Basavilbaso NG, Oneto A, Basso A. Serum insulin-like growth factor-1 measurement in the diagnosis and follow-up of patients with acromegaly: preliminary data. Frontiers Horm Rev 2010; 38: 145-151. https://doi.org/10.1159/000318504

Daughaday WH, Rotwein P. Insulin-like growth factors I and II. Peptide, messenger ribonucleic acid and gene structures, serum, and tissue concentrations. Endocrine Rev 1989; 10: 68-91. https://doi.org/10.1210/edrv-10-1-68

Jaffe CA, Pan W, Brown MB, DeMott-Friberg R, Barkan AL. Regulation of GH secretion in acromegaly: reproducibility of daily GH profiles and attenuated negative feedback by IGF-I. J Clin Endocrinol Metab 2001; 86: 4364-4370. https://doi.org/10.1210/jcem.86.9.7840

Massart C, Poirier JY. Determination of serum insulinlike growth factor-I reference values for the automated chemiluminescent Liaison(R) assay. Clinical utility in the follow-up of patients with treated acromegaly. Clin Chim Acta: Internat J Clin Chem 2011; 412: 398-399. https://doi.org/10.1016/j.cca.2010.10.025

Clemmons DR. Clinical laboratory indices in the treatment of acromegaly. Clin Chim Acta: Internat J Clin Chem 2011; 412: 403-409. https://doi.org/10.1016/j.cca.2010.11.008

Tanaka S, Fukuda I, Hizuka N, Takano K. Gender differences in serum GH and IGF-I levels and the GH response to dynamic tests in patients with acromegaly. Endocrin Journal 2010; 57: 477-483. https://doi.org/10.1507/endocrj.K09E-342

Clinical Laboratory Improvement Amendments (CLIA). https://www.cms.gov/clia/. Accesado el 15 de septiembre de 2011.

Grottoli S, Gasco V, Ragazzoni F, Ghigo E. Hormonal diagnosis of GH hypersecretory states. J Endocrinol Invest 2003; 26: 27-35. https://doi.org/10.1007/BF03345139

Pokrajac A, Wark G, Ellis AR, Wear J, Wieringa GE, Trainer PJ. Variation in GH and IGF-I assays limits the applicability of international consensus criteria to local practice. Clinical Endocrinology 2007; 67: 65-70. https://doi.org/10.1111/j.1365-2265.2007.02836.x

Cazabat L, Souberbielle JC, Chanson P. Dynamic tests for the diagnosis and assessment of treatment efficacy in acromegaly. Pituitary 2008; 11: 129-139. https://doi.org/10.1007/s11102-008-0113-7

Carmichael JD, Bonert VS, Mirocha JM, Melmed S. The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. J Clin Endocrinol Metab 2009; 94: 523-527. https://doi.org/10.1210/jc.2008-1371

Arafat AM, Möhlig M, Weickert MO, Perschel FH, Purschwitz J, Spranger J, et al. Growth hormone response during OGTT: the impact of assay method on the estimation of reference values in patients with acromegaly and in healthy controls and the role of gender, age, and body mass index. J Clin Endocrin Metab 2008, 93: 1254-62.

Bangham DR, Gaines Das RE, Schulster D. The In- ternational Standard for Human Growth Hormone for Bioassay: calibration and characterization by international collaborative study. Mol Cell Endocrinol. 1985; 42: 269-282. https://doi.org/10.1016/0303-7207(85)90058-9

Markkanen H, Pekkarinen T, Välimäki MJ, Alfthan H, Kauppinen-Makelin R, Sane T, et al. Effect of sex and assay method on serum concentrations of growth hormone in patients with acromegaly and in healthy controls. Clin Chem 2006; 52: 468-473. https://doi.org/10.1373/clinchem.2005.060236

Trainer PJ, Barth J, Sturgeon C, Wieringaon G. Consensus statement on the standardization of GH assays. Eur J Endocrinol 2006; 155: 1-2. https://doi.org/10.1530/eje.1.02186

Reutens AT, Hoffman DM, Leung KC, Ho KK. Evaluation and application of a highly sensitive assay for serum growth hormone (GH) in the study of adult GH deficiency. J Clin Endocrinol Metab 1995; 80: 480- 485. https://doi.org/10.1210/jcem.80.2.7852508

Ho KY, Weissberger AJ. Characterization of 24-hour growth hormone secretion in acromegaly: implications for diagnosis and therapy. Clin Endocrinol (Oxf) 1994; 41: 75-83. https://doi.org/10.1111/j.1365-2265.1994.tb03787.x

Dimaraki EV, Jaffe CA, DeMott-Friberg R, Chandler WF, Barkan AL. Acromegaly with apparently normal GH secretion: implications for diagnosis and follow-up. J Clin Endocrinol Metab 2002; 87:3537-3542. https://doi.org/10.1210/jcem.87.8.8658

Hiden U, Glitzner E, Hartmann M, Desoye G. Insulin and the IGF system in the human placenta of normal and diabetic pregnancies. J Anat 2009; 215: 60-68. https://doi.org/10.1111/j.1469-7580.2008.01035.x

Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, Casanueva FF, et al. A consensus on cri- teria for cure of acromegaly. J Clin Endocrinol Metab 2010; 95: 3141-3148. https://doi.org/10.1210/jc.2009-2670

Kreitschmann-Andermahr I, Suarez P, Jennings R, Evers N, Brabant G. GH/IGF-I regulation in obesity-mechanisms and practical consequences in children and adults. Horm Res Paediatrics 2010; 73: 153-160. https://doi.org/10.1159/000284355

Irie M, Tsushima T. Increase of serum growth hormone concentration following thyrotropin-releasing hormone injection in patients with acromegaly or gigantism. J Clin Endocrinol Metab 1972; 35: 97-100. https://doi.org/10.1210/jcem-35-1-97

Dökmetas HS, Selçuklu A, Colak R, Unlühizarci K, Bayram F, Kelestimur F. Pituitary apoplexy probably due to TRH and GnRH stimulation tests in a patient with acromegaly. J Endocrinol Invest 1999; 22: 698- 700. https://doi.org/10.1007/BF03343632

De Marinis L, Zuppi P, Valle D, Mancini A, Bianchi A, Lauriola L, et al. A retrospective hormonal and immunohistochemical evaluation of 47 acromegalic patients: prognostic value of preoperative plasma prolactin. Horm Metab Res 2002; 34: 137-143. https://doi.org/10.1055/s-2002-23197

Moore JS, Monson JP, Kaltsas G, Putignano P, Wood PJ, Sheppard MC, et al. Modulation of 11beta-hydroxysteroid dehydrogenase isozymes by growth hormone and insulin-like growth factor: in vivo and in vitro studies. J Clin Endocrinol Metab 1999; 84: 4172-4177. https://doi.org/10.1210/jcem.84.11.6108

Freda PU. Current concepts in the biochemical assessment of the patient with acromegaly. Growth Horm & IGF Research 2003; 13: 171-184. https://doi.org/10.1016/S1096-6374(03)00029-7

Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000; 85: 526-529. https://doi.org/10.1210/jc.85.2.526

Melmed S, Casanueva FF, Cavagnini F, Chanson P, Frohman L, Grossman A, et al. Guidelines for acromegaly management. J Clin Endocrinol Metab 2002; 87: 4054-4058. https://doi.org/10.1210/jc.2002-011841

Cook DM, Ezzat S, Katznelson L, Kleinberg DL, Laws ER, Jr., Nippoldt TB, et al. AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocrine Practice 2004; 10: 213-225. https://doi.org/10.4158/EP.10.3.213

Kauppinen-Makelin R, Sane T, Reunanen A, Valimaki MJ, Niskanen L, Markkanen H, et al. A nationwide survey of mortality in acromegaly. J Clin Endocrinol Metab 2005; 90: 4081-4086. https://doi.org/10.1210/jc.2004-1381

Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 2004; 89: 667-674. https://doi.org/10.1210/jc.2003-031199

Holdaway IM, Bolland MJ, Gamble GD. A meta- analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. European J Endocrinol 2008; 159: 89-95. https://doi.org/10.1530/EJE-08-0267

Verhaeghe J. Does the physiological acromegaly of pregnancy benefit the fetus? Gynecol Obst Invest 2008 2008; 66: 217-226. https://doi.org/10.1159/000147167

Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Pregnancy and pituitary disorders. European J Endocrinol 2010; 162: 453-475. https://doi.org/10.1530/EJE-09-0923

Igout A, Frankenne F, L'Hermite-Baleriaux M, Martin A, Hennen G. Somatogenic and lactogenic activity of the recombinant 22 kDa isoform of human placental growth hormone. Growth Regulation 1995; 5: 60-65.

Hisano M, Sakata M, Watanabe N, Kitagawa M, Mu- rashima A, Yamaguchi K. An acromegalic woman first diagnosed in pregnancy. Archives of gynecology and obstetrics 2006; 274: 171-173. https://doi.org/10.1007/s00404-005-0114-y

Bronstein MD, Paraiba DB, Jallad RS. Management of pituitary tumors in pregnancy. Nature Rev Endocrinol 2011; 7: 301-310. https://doi.org/10.1038/nrendo.2011.38

Beckers A, Stevenaert A, Foidart JM, Hennen G, Frankenne F. Placental and pituitary growth hormone secretion during pregnancy in acromegalic women. J Clin Endocrinol Metab 1990; 71: 725-731. https://doi.org/10.1210/jcem-71-3-725

Chang-DeMoranville BM, Jackson IM. Diagnosis and endocrine testing in acromegaly. Endocrinol Metab Clin North Am 1992; 21: 649-668. https://doi.org/10.1016/S0889-8529(18)30207-X

Costa AC, Rossi A, Martinelli CE, Jr., Machado HR, Moreira AC. Assessment of disease activity in treated acromegalic patients using a sensitive GH assay: should we achieve strict normal GH levels for a biochemical cure? J Clin Endocrinol Metab 2002; 87: 3142-3147. https://doi.org/10.1210/jcem.87.7.8631

Lim DJ, Kwon HS, Cho JH, Kim SH, Choi YH, Yoon KH, et al. Acromegaly associated with type 2 diabetes showing normal IGF-1 levels under poorly controlled glycemia. Endocrine Journal 2007; 54: 537-541.

https://doi.org/10.1507/endocrj.K06-083

Clayton KL, Holly JM, Carlsson LM, Jones J, Cheetham TD, Taylor AM, et al. Loss of the normal relationships between growth hormone, growth hormone-binding protein and insulin-like growth factor-I in adolescents with insulin-dependent diabetes mellitus. Clinical Endocrinology 1994; 41: 517-524. https://doi.org/10.1111/j.1365-2265.1994.tb02584.x

Espinosa-de-Los-Monteros AL, Gonzalez B, Vargas G, Sosa E, Mercado M. Clinical and biochemical characteristics of acromegalic patients with different abnormalities in glucose metabolism. Pituitary 2010. https://doi.org/10.1007/s11102-010-0284-x

Herlihy OM, Perros P. Elevated serum growth hormone in a patient with Type 1 diabetes: a diagnostic dilemma. Diabetes/Metab Res Rev 2000 2000; 16: 211-216. https://doi.org/10.1002/1520-7560(200005/06)16:3<211::AID-DMRR118>3.0.CO;2-S

Amiel SA, Sherwin RS, Hintz RL, Gertner JM, Press CM, Tamborlane WV. Effect of diabetes and its control on insulin-like growth factors in the young subject with type I diabetes. Diabetes 1984; 33: 1175-1179. https://doi.org/10.2337/diab.33.12.1175

Cómo citar
1.
Rúa Marín C, Latorre Sierra G, Campuzano Maya G. Diagnóstico de acromegalia. Med. Lab. [Internet]. 1 de diciembre de 2011 [citado 8 de diciembre de 2021];17(11-12):511-3. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/374
Publicado
2011-12-01
Sección
La Clínica y el Laboratorio

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