Abstract
Purpose
Acromegaly is a disease associated with an increased risk for several kinds of neoplasms including colon and thyroid cancer. Although the association between acromegaly and pancreatic neoplasms has not been elucidated, it has recently been reported that GNAS gene mutations were found in 58% of intraductal papillary mucinous neoplasms (IPMNs), which are representative pancreatic cystic lesions, suggesting a link between IPMNs and acromegaly. To assess the prevalence of pancreatic cystic lesions in patients with acromegaly, we performed a retrospective cross-sectional single institute study.
Methods
Thirty consecutive acromegalic patients (20 females and 10 males; mean age, 60.9 ± 11.9 years) who underwent abdominal contrast-enhanced computed tomography or magnetic resonance imaging between 2007 and 2015 at Kobe University Hospital were recruited. We also analyzed the relationship between presence of pancreatic cystic lesions and somatic GNAS mutations in pituitary tumors.
Results
Seventeen of 30 (56.7%) patients studied had pancreatic cystic lesions. Nine of 17 patients (52.9%) were diagnosed with IPMNs based on imaging findings. These results suggest that the prevalence of IPMNs may be higher in acromegalic patients in acromegalic patients than historically observed in control patients (up to 13.5%). In patients with pancreatic cystic lesions, the mean patient age was higher and the duration of disease was longer than in those without pancreatic cystic lesions (67.0 ± 2.3 vs. 53.0 ± 2.7 years, p < 0.001, 15.5 ± 2.4 vs. 7.3 ± 2.8 years, p = 0.04). There were no differences in serum growth hormone levels or insulin-like growth factor standard deviation scores between these two groups (21.3 ± 6.4 vs. 23.0 ± 7.4 ng/ml, p = 0.86, 6.6 ± 0.5 vs. 8.0 ± 0.6, p = 0.70). Neither the presence of somatic GNAS mutation in a pituitary tumor nor low signal intensity of the tumor in T2 weighted magnetic resonance imaging was associated with the presence of pancreatic cystic lesions.
Conclusions
These data demonstrate that old or long-suffering patients with acromegaly have a higher prevalence of pancreatic cystic lesions. Moreover, the prevalence of pancreatic cystic lesions may be increased in acromegalic patients.
Similar content being viewed by others
References
Melmed S (2009) Acromegaly pathogenesis and treatment. J Clin Invest 119:3189–3202
Katznelson L, Laws ER Jr, Melmed S et al (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933–3951
Tirosh A, Shimon I (2017) Complications of acromegaly: thyroid and colon. Pituitary 20:70–75
Landis CA, Masters SB, Spada A et al (1989) GTPase inhibiting mutations activate the alpha chain of Gs and stimulate adenylyl cyclase in human pituitary tumours. Nature 340:692–696
Springer S, Wang Y, Dal Molin M et al (2015) A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 149:1501–1510
Bassi C, Sarr MG, Lillemoe KD et al (2008) Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management. J Gastrointest Surg 12:645–650
Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32
Tanaka M (2015) International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med 3:286
Gaujoux S, Salenave S, Ronot M et al (2014) Hepatobiliary and pancreatic neoplasms in patients with McCune–Albright syndrome. J Clin Endocrinol Metab 99:E97–E101
Katznelson L, Atkinson JL, Cook DM et al (2011) American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly–2011 update. Endocr Pract 17(Suppl 4):1–44
Hagiwara A, Inoue Y, Wakasa K et al (2003) Comparison of growth hormone-producing and non-growth hormone-producing pituitary adenomas: imaging characteristics and pathologic correlation. Radiology 228:533–538
Isojima T, Shimatsu A, Yokoya S et al (2012) Standardized centile curves and reference intervals of serum insulin-like growth factor-I (IGF-I) levels in a normal Japanese population using the LMS method. Endocr J 59:771–780
de Jong K, Nio CY, Hermans JJ et al (2010) High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroentero Hepatol 8:806–811
Ikeda M, Sato T, Morozumi A et al (1994) Morphologic changes in the pancreas detected by screening ultrasonography in a mass survey, with special reference to main duct dilatation, cyst formation, and calcification. Pancreas 9:508–512
Lee KS, Sekhar A, Rofsky NM et al (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084
Laffan TA, Horton KM, Klein AP et al (2008) Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 191: 802–807.
Cheng S, Gomez K, Serri O et al (2015) The role of diabetes in acromegaly associated neoplasia. PloS ONE 10:e0127276
Colao A, Cuocolo A, Marzullo P et al (1999) Impact of patient’s age and disease duration on cardiac performance in acromegaly: a radionuclide angiography study. J Clin Endocrinol Metab 84:1518–1523
Vitale G, Pivonello R, Auriemma RS et al (2005) Hypertension in acromegaly and in the normal population: prevalence and determinants. Clin Endocrinol 63:470–476
Matsumoto R, Fukuoka H, Iguchi G et al (2015) Accelerated telomere shortening in acromegaly; IGF-I induces telomere shortening and cellular senescence. PloS ONE 10:e0140189
Parker E, Newby LJ, Sharpe CC et al (2007) Hyperproliferation of PKD1 cystic cells is induced by insulin-like growth factor-1 activation of the Ras/Raf signalling system. Kidney Int 72:157–165
Yamamoto M, Matsumoto R, Fukuoka H et al (2016) Prevalence of simple renal cysts in acromegaly. Intern Med 55:1685–1690
Tanaka M, Fernandez-del Castillo C et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197
van Keimpema L, Nevens F, Vanslembrouck R et al (2009) Lanreotide reduces the volume of polycystic liver: a randomized, double-blind, placebo-controlled trial. Gastroenterology 137:1661–1668
Acknowledgements
We are grateful to Ms. M. Kitamura and Ms. C. Ogata for providing excellent assistance. This work was supported in part by Grants-in-Aid for Scientific Research from the Japanese Ministry of Education Science, Culture, Sports, Science, and Technology (15K09432, 24790945, 23659477, and 23591354), Grants-in-Aid for Scientific Research (research on hypothalamic-hypophyseal disorders) from the Ministry of Health, Labor and Welfare of Japan, Novo Nordisk, the Daiichi-Sankyo Foundation of Life Science, the Foundation of Growth Science, and the Naito Foundation.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Odake, Y., Fukuoka, H., Yamamoto, M. et al. Cross-sectional prevalence of pancreatic cystic lesions in patients with acromegaly, a single-center experience. Pituitary 20, 509–514 (2017). https://doi.org/10.1007/s11102-017-0810-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11102-017-0810-1