Cardiovascular Pathology in Acromegaly

Acromegaly patients have a two-fold higher mortality risk with high prevalence of hypertension and diabetes mellitus. Fortunately, this risk becomes comparable to the general population as growth hormone levels decrease <1 μg/L and normalization of insulin-like growth factor-1. Age of onset, disease duration, growth hormone levels, and hypertension are independent predictors of mortality. Surgery, radiation, and pharmacotherapy equally improve acromegaly induced cardiomyopathy by effectively controlling hormone hypersecretion, but somatostatin analogs have a unique ability to modify cardiac structure even when stringent criterion of disease control is not met through direct effect on cardiomyocyte proliferation and contractility. GH excess leads to concentric left ventricular hypertrophy and impaired diastolic filling with underlying interstitial fibrosis. Early detection and treatment are pivotal in ensuring reversibility of cardiac pathology before permanent changes develop. Once therapy is employed, cardiac remodeling happens rather quickly in a matter of months with effective lowering of GH/IGF-1. This brings home the most important message of early detection and starting effective therapy promptly, either it is surgery or pharmacotherapy when surgical cure is not possible or not achieved.