GIGANTISMO Y ACROMEGALIA PDF

Clinical and biochemical features in patients. Medicine ; Melmed S. In: Melmed S, Malden M. The Pituitary. Oxford: Blackwell Science Inc, ;

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Cardiovascular disturbances in acromegaly. Acromegaly causes a number of disorders in the cardiovascular system, resulting from chronic exposure to high levels of GH and IGF Such disorders are the main responsible for increased mortality rates among acromegalic patients.

Among several forms of cardiovascular impairment is acromegalic cardiomyopathy, an entity that is initially characterized by a hyperdynamic state, followed by concentric left ventricular hypertrophy and diastolic dysfunction due to relaxation deficit, culminating in systolic dysfunction and sometimes heart failure. In addition, arrhythmias and heart valve diseases are also relevant, especially mitral and aortic, ischemic heart disease, hypertension, and glucose and lipid metabolism disorders.

This review approaches the main clinical and prognostic aspects of these entities, the effects of acromegaly treatment on them, and the respective consequences on patient survival. Keywords: Acromegaly; Acromegalic cardiomyopathy; Secondary hypertension; Cardiovascular risk. Os efeitos do excesso de GH e IGF-1 sobre o crescimento acral e visceral e sobre o metabolismo ocorrem insidiosamente. No recente estudo do Registro Espanhol de Acromegalia ocorreram 56 mortes em 1.

Mesmo entre pacientes tratados com cirurgia transesfenoidal, a mortalidade persiste elevada Casini e cols. Lopez-Velasco e cols. Colao e cols. Fatti e cols. Hermann e cols. Ohtsuka e cols. Pereira e cols. Chanson e cols. Del Rio e cols. Todos os pacientes desse estudo eram normotensos. Bondanelli e cols. Vilar e cols. Colao, citando Sonksen e cols. Baldelli e cols. Van der Lely e cols.

No trabalho de Sesmilo e cols. Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Melmed S. In: Melmed S, ed. The Pituitary. Massachusets: Blackwell Publishing. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. Medical progress: acromegaly. N Engl J Med. Cardiac abnormalities in acromegaly. Pathophysiology and implications for management. Treat Endocrinol. Clayton RN. Cardiovascular function in acromegaly.

Characterization of premature atherosclerosis of carotid arteries in acromegalic patients. Clin Endocrinol Oxf. Katznelson L. Current thinking on the management of the acromegalic patient. Curr Opin Endocrinol Diabetes Obes.

Eur J Endocrinol. Factors influencing mortality in acromegaly. J Clin Endocrinol Metabolism. Mortality in acromegaly: a metaanalysis. Casagrande A, Czepielewski MA. Growth hormone GH and IGF-I assays: methodological aspects and its implications in acromegaly diagnosis and follow-up. Arq Bras Endocrinol Metabol. Growth hormone and the heart. Clinical Endocrinology. Prevalence and determinants of left ventricular hypertrophy in acromegaly: impact of different methods of indexing left ventricular mass.

Cardiovascular effects of short-term growth hormone hypersecretion. Cardiac morphology and performance alterations and analysis of determinant factors of left ventricular hypertrophy in 40 patients with acromegaly. Cardiac involvement in acromegaly: specific myocardiopathy or consequence of systemic hypertension? Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. Progression of cardiovascular disease in acromegalic patients treated by external pituitary irradiation.

Acta Endocrinol Copenh. Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance. Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients. Evaluation of cardiac structure by echoreflectivity analysis in acromegaly: effects of treatment. Reversal of acromegalic cardiomyopathy in young but not in middle-aged patients after 12 months of treatment with the depot long-acting somatostatin analogue octreotide.

Impact of somatostatin analogs on the heart in acromegaly: a metaanalysis. Treatment with growth hormone receptor antagonist in acromegaly: effect on cardiac structure and performance.

Arrhythmia profile in acromegaly. Eur Heart J. Effects of treatment with somatostatin analogues on QT interval duration in acromegalic patients. Occurrence of ventricular late potentials in patients with active acromegaly.

Improvement of left ventricular hypertrophy and arrhythmias after lanreotide-induced GH and IGF-I decrease in acromegaly. A prospective multi-center study. J Endocrinol Invest. High prevalence of cardiac valve disease in acromegaly: an observational, analytical, case-control study. Lie JT. Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients. Am Heart J.

Heart valve operation in acromegaly. Ann Thorac Surg. Increased prevalence of regurgitant valvular heart disease in acromegaly. Uncontrolled acromegaly is associated with progressive mitral valvular regurgitation. Valvular heart disease and the use of dopamine agonists for Parkinson's disease. Dopamine agonists and the risk of cardiac-valve regurgitation. Ross R. Atherosclerosis-an inflammatory disease. New England Journal of Medicine. Decreased regional blood flow in patients with acromegaly.

Vascular reactivity in acromegalic patients: preliminary evidence for regional endothelial dysfunction and increased sympathetic vasoconstriction. Early vascular alterations in acromegaly. Morphologic study of microcirculation in acromegaly by capillaroscopy. Increased arterial intima-media thickness by B-M mode echodoppler ultrasonography in acromegaly. A nationwide survey of mortality in acromegaly. Acromegaly and coronary disease: an integrated evaluation of conventional coronary risk factors and coronary calcifications detected by computed tomography.

Risk factors for development of coronary heart disease in patients with acromegaly: a five-year prospective study. Hypertension in acromegaly and in the normal population: prevalence and determinants. N-terminal pro-B-type natriuretic peptide in patients with growth hormone disturbances.

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Em , foram publicadas diretrizes para o manejo da acromegalia, o qual envolve, muitas vezes, uma abordagem multidisciplinar. Acromegaly is a disabling and disfiguring illness, which, if not adequately controlled, decreases life expectancy. Cardiovascular and respiratory complications represent the main causes of death in acromegalic patients. Progress in all therapeutic modalities has been made, allowing biochemical disease control in more patients. In , the guidelines for management of acromegaly were published which encompass, many times, a multidisciplinary approach. In this article, we critically evaluate what is available in Brazil that allows us to follow the guidelines established in the diagnosis and treatment consensus.

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