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Acromegaly and ultrasound: how, when and why?

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Abstract

Background

Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease.

Purpose

This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger.

Conclusions

Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.

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Fig. 1

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Abbreviations

US:

Ultrasound

GH:

Growth hormone

IGF-1:

Insulin-like growth factor

ACRO:

Acromegaly patients

LVH:

Left ventricular hypertrophy

IMT:

Carotid intima media thickness

PWV:

Pulse wave velocity

FMD:

Flow-mediated dilation

RRI:

Renal resistive index

PCOS:

Polycystic ovary syndrome

ACRO-cats:

Cats with acromegaly

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Acknowledgements

We thank Giulia Maddalena, MD for her contribution to Fig. 1 and Dr. Marino Parolin, DVM for his contributions to the paragraphs concerning feline acromegaly. Editorial assistance for the preparation of this manuscript was provided by Alexandra Wennberg, Ph.D.

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  1. Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy

    M. Parolin, F. Dassie, R. Vettor & P. Maffei

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Parolin, M., Dassie, F., Vettor, R. et al. Acromegaly and ultrasound: how, when and why?. J Endocrinol Invest 43, 279–287 (2020). https://doi.org/10.1007/s40618-019-01111-9

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