Back
 IJCM  Vol.10 No.10 , October 2019
Respiratory Disorders in Acromegalic Patients
Abstract: Purpose: To evaluate the prevalence and clinical performance of obstructive sleep apnoea syndrome (OSAS) in acromegalic patients, focusing on the possible correlation between alterations of pulmonary microcirculation and patient’s clinical and hormonal parameters. Methods: We enrolled 22 acromegalic patients with apnea hypopnea index (AHI) ≥ 5 if symptomatic, or ≥15 in the absence of sleep related symptoms. Patients underwent the following evaluations: GH and IGF-1 serum levels, arterial blood gas test, spirometry, carbon monoxide diffusing capacity (DLCO), home-based cardiorespiratory sleep and pulmonary function test. Results: The prevalence of OSAS was 66.6%. Patients with a severe form of OSAS appeared to be affected from acromegaly for more years than those with a lower severity of disease and those with acromegaly duration > 10 years had significantly higher levels of glycated hemoglobin. We observed a positive correlation between GH level at diagnosis and DLCO value, showing that acromegalic patients have an increase in static and dynamic respiratory volumes and alveolar-capillary exchange surface compared to the general population. We also observed a positive correlation between baseline serum IGF-1 level and DLCO/VA and between years of disease and DLCO/VA, showing the association of increased lung volume and increase of the exchange surface. Conclusions: The results of this study add new information on lung volume and alveolar gas exchange in acromegaly. Our findings highlight the role of SSA as therapy with positive impact on complication and comorbidities of acromegaly.
Cite this paper: Mercuri, V. , Villani, T. , Costa, D. , Mordenti, M. , D’Amico, T. , Palange, P. and Gargiulo, P. (2019) Respiratory Disorders in Acromegalic Patients. International Journal of Clinical Medicine, 10, 553-564. doi: 10.4236/ijcm.2019.1010045.
References

[1]   Melmed, S. (2006) Acromegaly. The New England Journal of Medicine, 355, 2558-2573.
https://doi.org/10.1056/NEJMra062453

[2]   Davì, M.V. and Giustina, A. (2012) Sleep Apnea in Acromegaly: A Review on Prevalence, Pathogenetic Aspects and Treatment. Expert Review of Endocrinology and Metabolism, 7, 55-62.
https://doi.org/10.1586/eem.11.82

[3]   Vannucci, L., Luciani, P., Gagliardi, E., Paiano, S., Duranti, R., et al. (2013) Assessment of Sleep Apnea Syndrome in Treated Acromegalic Patients and Correlation of Its Severity with Clinical and Laboratory Parameters. Journal of Endocrinological Investigation, 36, 237-242.

[4]   Fatti, L.M., Scacchi, M., Pincelli, A.I., Lavezzi, E. and Cavagnini, F. (2001) Prevalence and Pathogenesis of Sleep Apnea and Lung Disease in Acromegaly. Pituitary, 4, 259-262.
https://doi.org/10.1023/A:1020702631793

[5]   Berry, R.B., Budhiraja, R., Gottlieb, D.J., Gozal, D., Iber, C., et al. (2012) Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 8, 597-619.
https://doi.org/10.5664/jcsm.2172

[6]   Katznelson, L., Laws, E.R., Melmed, S., Molitch, M.E., Murad, M.H., et al. (2014) Acromegaly: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 99, 3933-3951.
https://doi.org/10.1210/jc.2014-2700

[7]   Giustina, A., Casanueva, F.F., Cavagnini, F., Chanson, P., Clemmons, D., et al. (2003) Diagnosis and Treatment of Acromegaly Complications. Journal of Endocrinological Investigation, 26, 1242-1247.
https://doi.org/10.1007/BF03349164

[8]   Melmed, S., Casanueva, F.F., Klibanski, A., Bronstein, M.D., Chanson, P., et al. (2012) A Consensus on the Diagnosis and Treatment of Acromegaly Complications. Pituitary, 16, 294-302.
https://doi.org/10.1007/s11102-012-0420-x

[9]   Johns, M.W. (1991) A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545.
https://doi.org/10.1093/sleep/14.6.540

[10]   Epstein, L.J., Kristo, D., Strollo, P.J., Friedman, N., Malhotra, A., et al. (2009) Clinical Guideline for the Evaluation, Management and Long-Term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medicine, 5, 263-276.

[11]   Commissione Paritetica Associazione Italiana Medicina del Sonno (AIMS), Associazione Italiana Pneumologi Ospedalieri (AIPO) (2001) Linee guida di procedura diagnostica nella sindrome delle apnee ostruttive nel sonno dell’adulto.
http://www.sonnomed.it/linee_guida.htm

[12]   Attal, P. and Chanson, P. (2010) Endocrine Aspects of Obstructive Sleep Apnea. The Journal of Clinical Endocrinology & Metabolism, 95, E483-E495.
https://doi.org/10.1210/jc.2009-1912

[13]   Guo, X., Gao, L., Zhao, Y., Wang, M., Jiang, B., et al. (2018) Characteristics of the Upper Respiratory Tract with Acromegaly and Correlations with Obstructive Sleep Apnoea/Hypopnea Syndrome. Sleep Medicine, 48, 27-34.
https://doi.org/10.1016/j.sleep.2018.04.011

[14]   De Menis, E., Giustina, A., Colao, A., Degli Uberti, E., Ghigo, E., et al. (2011) Assessment of the Awareness and Management of Sleep Apnea Syndrome in Acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group. Journal of Endocrinological Investigation, 34, 60-64.
https://doi.org/10.1007/BF03346696

[15]   Ceccato, F., Bernkopf, E. and Scaroni, C. (2015) Sleep Apnea Syndrome in Endocrine Clinics. Journal of Endocrinological Investigation, 38, 827-834.
https://doi.org/10.1007/s40618-015-0338-z

[16]   Rosenow, F., McCarthy, V. and Caruso, A.C. (1998) Sleep Apnoea in Endocrine Diseases. Journal of Sleep Research, 7, 3-11.
https://doi.org/10.1046/j.1365-2869.1998.00086.x

[17]   Cadieux, R.J., Kales, A., Santen, R.J., Bixler, E.O. and Gordon, R. (1982) Endoscopic Findings in Sleep Apnoea Associated with Acromegaly. The Journal of Clinical Endocrinology & Metabolism, 55, 18-22.
https://doi.org/10.1210/jcem-55-1-18

[18]   Dostalova, S., Sonka, K., Smahel, Z., Weiss, V., Marek, J., et al. (2001) Craniofacial Abnormalities and Their Relevance for Sleep Apnoea Syndrome Aetiopathogenesis in Acromegaly. European Journal of Endocrinology, 144, 491-497.
https://doi.org/10.1530/eje.0.1440491

[19]   Davi, M.V., Dalle Carbonare, L., Giustina, A., Ferrari, M., Frigo, A., et al. (2008) Sleep Apnoea Syndrome Is Highly Prevalent in Acromegaly and Only Partially Reversible after Biochemical Control of the Disease. European Journal of Endocrinology, 159, 533-540.
https://doi.org/10.1530/EJE-08-0442

[20]   Roemmler, J., Gutt, B., Fischer, R., Vay, S., Wiesmeth, A., et al. (2012) Elevated Incidence of Sleep Apnoea in Acromegaly-Correlation to Disease Activity. Sleep and Breathing, 16, 1247-1253.
https://doi.org/10.1007/s11325-011-0641-7

[21]   Weiss, V., Sonka, K., Pretl, M., Dosta’lova’, S., Klozar, J., et al. (2000) Prevalence of the Sleep Apnea Syndrome in Acromegaly Population. Journal of Endocrinological Investigation, 23, 515-519.
https://doi.org/10.1007/BF03343767

[22]   Tsoi, U.A., Sviryaev, Y.V., Korostovtseva, L.S., Semenov, A.P., Vaulina, D.A., et al. (2015) Clinical Features of Obstructive Sleep Apnea Syndrome in Patients with Acromegaly. Terapevticheskii Arkhiv, 87, 47-52.
https://doi.org/10.17116/terarkh201587447-52

[23]   Brody, J.S., Fisher, A.B., Gocmen, A. and DuBois, A.B. (190) Acromegalic Pneumonomegaly: Lung Growth in the Adult. Journal of Clinical Investigation, 49, 1051-1060.
https://doi.org/10.1172/JCI106321

[24]   Creutzberg, E.C. and Casaburi, R. (2003) Endocrinological Disturbances in Chronic Obstructive Pulmonary Disease. European Respiratory Journal, 46, 76s-80s.
https://doi.org/10.1183/09031936.03.00004610

[25]   Vogiatzis, I., Stratakos, G., Simoes, D.C., Terzis, G., Georgiadou, O., et al. (2007) Effects of Rehabilitative Exercise on Peripheral Muscle TNF, IL-6, IGF-I and MyoD Expression in Patients with COPD. Thorax, 62, 950-956.
https://doi.org/10.1136/thx.2006.069310

[26]   Glaser, J., Friedrich, N., Ewert, R., Schäper, C., Nauck, M., et al. (2009) Association between Serum Insulin-Like Growth Factor (IGF) I and IGF Binding Protein-3 and Lung Function. The Journal of Clinical Endocrinology & Metabolism, 94, 2452-2458.
https://doi.org/10.1210/jc.2008-2662

[27]   Dobrucki, L.W., Tsutsumi, Y., Kalinowski, L., Dean, J., Gavin, M., et al. (2010) Analysis of Angiogenesis Induced by Local IGF-1 Expression after Myocardial Infarction Using MicroSPECT-CT Imaging. Journal of Molecular and Cellular Cardiology, 48, 1071-1079.
https://doi.org/10.1016/j.yjmcc.2009.10.008

[28]   Rabinovsky, E.D. and Draghia-Akli, R. (2004) Insulin-Like Growth Factor I Plasmid Therapy Promotes in Vivo Angiogenesis. Molecular Therapy, 9, 46-55.
https://doi.org/10.1016/j.ymthe.2003.10.003

[29]   Iandelli, I., Gorini, M., Duranti, R., Bassi, F., Misuri, G., et al. (1997) Respiratory Muscle Function and Control of Breathing in Patients with Acromegaly. European Respiratory Journal, 10, 977-982.
https://doi.org/10.1183/09031936.97.10050977

[30]   Luboshitzky, R. and Barzilai, D. (1980) Hypoxemia and Pulmonary Function in Acromegaly. The American Review of Respiratory Disease, 121, 471-475.
https://doi.org/10.1164/arrd.1980.121.3.471

[31]   Kamenicky, P., Viengchareun, S., Blanchard, A., Meduri, G., Zizzari, P., et al. (2008) Epithelial Sodium Channel Is a Key Mediator of Growth Hormone-Induced Sodium Retention in Acromegaly. Endocrinology, 149, 3294-3305.
https://doi.org/10.1210/en.2008-0143

[32]   Sicuro, A., Mahlbacher, K., Hulter, H.N. and Krapf, R. (1998) Effect of Growth Hormone on Renal and Systemic Acid-Base Homeostasis in Humans. American Journal of Physiology, 274, F650-F657.
https://doi.org/10.1152/ajprenal.1998.274.4.F650

 
 
Top