1,722,157 research outputs found
The GH-IGF-I axis and the cardiovascular system: clinical implications
No full textBACKGROUND: GH and IGF-I affect cardiac structure and performance. In the general population, low IGF-I has been associated with higher prevalence of ischaemic heart disease and mortality. Both in GH deficiency (GHD) and excess life expectancy has been reported to be reduced because of cardiovascular disease. OBJECTIVE: To review the role of the GH-IGF-I system on the cardiovascular system. RESULTS: Recent epidemiological evidence suggests that serum IGF-I levels in the low-normal range are associated with increased risk of acute myocardial infarction, ischaemic heart disease, coronary and carotid artery atherosclerosis and stroke. This confirms previous findings in patients with acromegaly or with GH-deficiency showing cardiovascular impairment. Patients with either childhood- or adulthood-onset GHD have cardiovascular abnormalities such as reduced cardiac mass, diastolic filling and left ventricular response at peak exercise, increased intima-media thickness and endothelial dysfunction. These abnormalities can be reversed, at least partially, after GH replacement therapy. In contrast, in acromegaly chronic GH and IGF-I excess causes a specific cardiomyopathy: concentric cardiac hypertrophy (in more than two-thirds of the patients at diagnosis) associated to diastolic dysfunction is the most common finding. In later stages, impaired systolic function ending in heart failure can occur, if GH/IGF-I excess is not controlled. Abnormalities of cardiac rhythm and of cardiac valves can also occur. Successful control of acromegaly is accompanied by decrease of the left ventricular mass and improvement of cardiac function. CONCLUSION: The cardiovascular system is a target organ for GH and IGF-I. Subtle dysfunction in the GH-IGF-I axis are correlated with increased prevalence of ischaemic heart disease. Acromegaly and GHD are associated with several abnormalities of the cardiovascular system and control of GH/IGF-I secretion reverses (or at least stops) cardiovascular abnormalities
Pituitary tumours: the prolactinoma
No full textThis review focus on the epidemiology, diagnosis and treatment of prolactinomas.
In particular, attention was given to recent data showing a high prevalence of
these tumours in the general population, 3-5 times higher than previously
reported. The diagnosis of hyperprolactinaemia has been simplified in recent
years, and only prolactin (PRL) assay and magnetic resonance imaging of the sella
are required. Nonetheless, macroprolactinaemia should be assessed in patients
with hyperprolactinaemia in the absence of clinical symptoms of elevated PRL
levels. The recent evidence that medical therapy with dopamine agonists should be
continued lifelong has been confirmed by several studied. The patients achieving
disappearance of the tumours and suppression of PRL levels during treatment are
those showing the highest likelihood to have persistent remission of
hyperprolactinaemia after treatment withdrawal
Long-term acromegaly and associated cardiovascular complications: a case-based review.
No full textBecause growth hormone and IGF-1 both have regulatory roles in the cardiovascular
system, patients with acromegaly often present with abnormalities of heart
structure and function and the vascular system, which if left unmanaged can
reduce life expectancy. Early symptoms of acromegalic cardiomyopathy
(hyperkinetic syndrome) can be characterized by cardiac hypertrophy, increased
heart rate, and increased systolic output. When left untreated, more pronounced
hypertrophy, signs of diastolic dysfunction and insufficient systolic function on
exertion arise, and can lead to systolic dysfunction at rest, and eventually
heart failure with signs of dilative cardiomyopathy. Increasingly, evidence
suggests that early diagnosis and treatment of acromegaly (before the age of 40
years) can help prevent the progression of cardiovascular disease, improve
quality of life, and reduce the risk of premature mortality. This review focuses
on management strategies for newly diagnosed patients with acromegaly and
evidence of cardiovascular disease. The roles of surgery and medical treatment
are discussed in the context of using optimal treatment strategies to help
reverse cardiac hypertrophy and normalize other cardiac risk factors
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