Abstract
Acromegaly, when left untreated, is associated with premature mortality which is chiefly related to cardiovascular complications. We report on a 50-year-old acromegalic woman, resistant to therapy, who died suddenly because of thoracic aortic rupture and massive bleeding into the left pleural space. The postmortem examination disclosed, nearby the point of rupture, a pulmonary abscess as well as extensive intrinsic alteration of arteries originating from the aortic arch and aorta itself, which featured microscopic cystic medial necrosis. We discussed how these aspects could be related to long-term exposition to growth hormone excess. In particular, this case gives further evidence of vascular system frailty in acromegaly.
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Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25:102–152
Rossi L, Thiene G, Caregaro L, Giordano R, Lauro S (1977) Dysrhythmias and sudden death in acromegalic heart disease. Chest 72:495–498
Hayward RP, Emanuel RW, Nabarro DN (1987) Acromegalic heart disease: influence of treatment of the acromegaly on the heart. Q J Med 237:41–58
Albat B, Leclerq FF, Serre I, Fille A, Baldet P, Grolleau-Raoux R, Thevenet A (1993) Heart transplantation for terminal congestive heart failure in an acromegalic patient. Eur Heart J 14:1572–1575
Ondreyco SM, Lewis HD, Hartman CR (1980) Myxomatous degeneration and cystic medial necrosis associated with acromegaly. Arch Intern Med 140:547–549
Agozzino L, Santé P, Ferraraccio F, Accardo M, De Feo M, De Santo LS, Nappi G, Agozzino M, Esposito S (2006) Ascending aorta dilatation in aortic valve disease: morphological analysis of medial changes. Heart Vessels 21:213–220
Bruel A, Oxlund H (1995) Biosynthetic growth hormone increases the collagen deposition rate in rat aorta and heart. Eur J Endocrinol 132:195–199
Erikstrup C, Pedersen LM, Heickendorff, L Ledet T, Rasmussen LM (2001) Production of hyaluronan and chondroitin sulphate proteoglycans from human arterial smooth muscle-the effect of glucose, insulin, IGF-I or growth hormone. Eur J Endocrinol 145: 193–198
Thogersen VB, Heichendorff L, Ledet T (1996) Effect of insulin and growth hormone on the synthesis of radiolabelled proteoglycans from cultured human arterial smooth muscle cells. Eur J Endocrinol 134:326–330
Kaku T, Nakashima Y, Ichiyasu H, Soejima M, Baba K, Kuroiwa A (1991) Ruptured chordae tendineae in acromegaly. An autopsy case. Jpn Heart J 32:521–527
Paya E, Marin F, Climent V, Pico AM, Martinez JG, Sogorb F (2003) Heart valve disease in acromegaly. Int J Cardiol 90:331–332
Pereira AM, van Thiel SW, Lindner JR, Roelfsema F, van der Wall EE, Morreau H, Smit JW, Romijn JA, Bax JJ (2004) Increased prevalence of regurgitant valvular heart disease in acromegaly. J Clin Endocrinol Metab 89:71–75
Colao A, Ferone D, Marzullo P, Panza N, Pivonello R, Orio F Jr, Grande G, Bevilacqua N, Lombardi G (2002) Lymphocyte subset pattern in acromegaly. J Endocrinol Invest 25:125–128
Van Hagen PM, Krenning EP, Kwekkeboom DJ, Reubi JC, Anker-Lugtenburg PJ, Lowenberg B, Lamberts SW (1994) Somatostatin and the immune and haematopoietic system; a review. Eur J Clin Invest 24:91–99
Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR (1999) Factors predicting mortality of patients with lung abscess. Chest 115:746–750
Harber P, Terry PB (1981) Fatal lung abscesses: review of 11 years’ experience. South Med J 74:281–283
Bansal P, Harrison P (1990) Salmonella lung abscess causing rupture of the thoracic aorta. Br J Hosp Med 43:296
Rogol PR (1988) Fatal hemoptysis due to lung abscess and pulmoaortic fistula. Chest 94:441–442
Takagi H, Nachi S, Matsuno Y, Umeda Y, Fukumoto Y, Mori Y (2005) Chronic contained rupture of the descending thoracic aorta due to infection by Escherichia coli. Heart Vessels 20:186–189
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Maffei, P., Menegazzo, C., Michelotto, M. et al. Sudden death due to aortic rupture in acromegaly. Heart Vessels 23, 71–74 (2008). https://doi.org/10.1007/s00380-007-1012-y
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DOI: https://doi.org/10.1007/s00380-007-1012-y