Increased Risk of Hip Fracture in Patients with Acromegaly: A Nationwide Cohort Study in Korea

김지원,홍남기,최지미,문주형,김의현,이은직,김신곤,구철룡 대한내분비학회 2023 Endocrinology and metabolism Vol.38 No.6

Background: Acromegaly leads to various skeletal complications, and fragility fractures are emerging as a new concern in patients with acromegaly. Therefore, this study investigated the risk of fractures in Korean patients with acromegaly. Methods: We used the Korean nationwide claims database from 2009 to 2019. A total of 931 patients with acromegaly who had never used an osteoporosis drug before and were treated with surgery alone were selected as study participants, and a 1:29 ratio of 26,999 age- and sex-matched osteoporosis drug-naïve controls without acromegaly were randomly selected from the database. Results: The mean age was 46.2 years, and 50.0% were male. During a median follow-up of 54.1 months, there was no difference in the risks of all, vertebral, and non-vertebral fractures between the acromegaly and control groups. However, hip fracture risk was significantly higher (hazard ratio [HR], 2.73; 95% confidence interval [CI], 1.32 to 5.65), and non-hip and non-vertebral fractures risk was significantly lower (HR, 0.40; 95% CI, 0.17 to 0.98) in patients with acromegaly than in controls; these results remained robust even after adjustment for socioeconomic status and baseline comorbidities. Age, type 2 diabetes mellitus, cardio-cerebrovascular disease, fracture history, recent use of acid-suppressant medication, psychotropic medication, and opioids were risk factors for all fractures in patients with acromegaly (all P<0.05). Conclusion: Compared with controls, patients surgically treated for acromegaly had a higher risk of hip fractures. The risk factors for fracture in patients with acromegaly were consistent with widely accepted risk factors in the general population.

Descriptive Epidemiology and Survival Analysis of Acromegaly in Korea

Yun Soo Jin,Lee Jung Kuk,Park So Young,Chin Sang Ouk 대한의학회 2021 Journal of Korean medical science Vol.36 No.23

Background: Acromegaly is a rare, slowly progressive disease. Its mechanism is not fully understood, and epidemiological research on Korean patients with acromegaly is scarce. The purpose of this study was to determine the incidence and prevalence of acromegaly and assess the comorbidities and survival benefits based on treatment options. Methods: This nationwide population-based cohort study was conducted using data of the Korean Health Insurance Review and Assessment claims database to evaluate the incidence of newly diagnosed acromegaly cases during 2013–2017. Results: During the 5-year period, 1,093 patients were newly diagnosed with acromegaly. The average annual incidence was 4.2 cases per million per year, and the prevalence was 32.1 cases per million during this period. The incidence of hypertension was low after medical treatment (hazard ratio, 0.257; 95% confidence interval, 0.082–0.808; P = 0.020), but the incidence of diabetes showed no significant difference across treatment modalities. Over a period of 6 years since diagnosis, we found that patients treated for acromegaly had a significantly higher survival rate than those untreated (P < 0.001). Conclusion: The annual incidence rate of Korean patients with acromegaly was similar to that reported in previous studies. Using nationwide population data, our study emphasized the importance of treatment in acromegaly patients.

Multiomics Approach to Acromegaly: Unveiling Translational Insights for Precision Medicine

김경원,구철룡,이은직 대한내분비학회 2023 Endocrinology and metabolism Vol.38 No.5

The clinical characteristics and prognoses of acromegaly vary among patients. Assessment of current and novel predictors can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and a reduction in the increased morbidity and mortality associated with acromegaly. Despite advances in the diagnosis and treatment of acromegaly, its pathophysiology remains unclear. Recent advancements in multiomics technologies, including genomics, transcriptomics, proteomics, metabolomics, and radiomics, have offered new opportunities to unravel the complex pathophysiology of acromegaly. This review comprehensively explores the emerging role of multiomics approaches in elucidating the molecular landscape of acromegaly. We discuss the potential implications of multiomics data integration in the development of novel diagnostic tools, identification of therapeutic targets, and the prospects of precision medicine in acromegaly management. By integrating diverse omics datasets, these approaches can provide valuable insights into disease mechanisms, facilitate the identification of diagnostic biomarkers, and identify potential therapeutic targets for precision medicine in the management of acromegaly.

Precision Therapy in Acromegaly: How Close Is It to Reality?

구철룡,Vladimir Melnikov,Zhaoyun Zhang,이은직 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.2

Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormoneelevations, commonly due to endocrinologic hypersecretion from a pituitary gland tumor. Comprehensive national acromegaly databases have been appearing over the years, allowing for international comparisons of data, although still presenting varying prevalence and incidence rates. Lack of large-scale analysis in geographical and ethnic differences in clinical presentation and management requires further research. Assessment of current and novel predictors of responsiveness to distinct therapy can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and reduction of increased morbidity and mortality associated with acromegaly. This review compares current data from epidemiological studies and assesses the present-day applicationof prognostic factors in medical practice, the reality of precision therapy, as well as its future prospects in acromegaly, with a specialfocus on its relevance to the South Korean population.

말단비대증 환자에서 소마토스타틴 유사체 사용에 대한 권고안

진상욱 ( Sang Ouk Chin ),구철룡 ( Cheol Ryong Ku ),김병준 ( Byung Joon Kim ),김성운 ( Sung-woon Kim ),박경혜 ( Kyeong Hye Park ),송기호 ( Kee Ho Song ),오승준 ( Seungjoon Oh ),윤현구 ( Hyun Koo Yoon ),이은직 ( Eun Jig Lee ),이정민 대한내과학회 2019 대한내과학회지 Vol.94 No.6

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical man-agement is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrep-ancies among expert opinions, the experts voted to determine the recommended approach. (Korean J Med 2019;94:485-494)

말단비대증 환자에서 발생한 급성 림프구백혈병

오영승 ( Young Seung Oh ),최민석 ( Min Seok Choi ),신진경 ( Jin Kyeong Shin ),권희선 ( Hee Sun Kwon ),손장원 ( Jang Won Son ),김성래 ( Sung Rae Kim ),유순집 ( Soon Jib Yoo ) 대한내과학회 2016 대한내과학회지 Vol.90 No.3

Acromegaly is a rare disorder caused by excessive amounts of growth hormone. The incidence of colorectal, breast, and thyroid carcinomas is increased in acromegaly. However, there have been few reports on hematological malignancies in acromegaly. We describe a patient who developed acute lymphoblastic leukemia during the course of acromegaly. A 35-year-old woman presented in February 2012 with unexplained lactation and amenorrhea for 4 months. Her growth hormone level was 12.6 μg/L, insulin-like growth factor 1 592.26 ng/mL, and prolactin 242 μg/L. A pituitary macroadenoma secreting GH and prolactin causing acromegaly was diagnosed. Considering her fertility, the dopamine agonist cabergoline 0.5 mg was administered in March 2012. In February 2014, she presented with cytopenia (hemoglobin 12.2 g/dL, white cell count 2.69 × 109/L, platelets 39 × 109/L) and hepatosplenomegaly. A bone marrow examination showed acute B cell lymphoblastic leukemia. She underwent chemotherapy and bone marrow transplantation. A follow-up bone marrow biopsy showed remission. (Korean J Med 2016;90:243-247)

뇌하수체 선종 제거 후 요붕증이 발생한 말단비대증에서 성공적인 출산

김세현,김주일,박예민,원인식,신권철,조윤정,이시훈,김연선,이기영,박이병 대한내분비학회 2010 Endocrinology and metabolism Vol.25 No.1

A 33-year-old woman visited our hospital because of oligomenorrhea. Acromegaly was diagnosed based on elevated insulin like growth factor-I (IGF-I) and paradoxical growth hormone (GH) rise in oral glucose tolerance test. Pituitary macroadenoma was detected on magnetic resonance imaging (MRI). The pituitary tumor was removed. Still, diabetes insipidus developed. We prescribed desmopressin and bromocriptine. Two months post-surgery, IGF-I was decreased and a combined pituitary function test was normal, except for the follicle stimulating hormone response. Residual tumor was detected on MRI. The bromocriptine dose was increased and treatment with the long-acting somatostatin analogue octreotide long acting release (LAR) was begun. After the fifth round of octreotide LAR, IGF-I was normalized. After the seventh round of octreotide LAR, the patient became pregnant. Bromocriptine and octreotide LAR were stopped, and desmopressin was continued. Successful delivery occurred at week 38 of pregnancy. The patient was discharged without any complications. Acromegaly is a disease caused by chronic GH hypersecretion, generally related to a somatotroph adenoma. Amenorrhea and menstrual irregularities are common in acromegaly. Pregnancy rarely occurs because chronic anovulation usually exists. When gonadotroph axis was preserved, the possibility of pregnancy in a woman of child-bearing age with acromegaly should be considered.

Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement

진상욱,Cheol Ryong Ku,김병준,김성운,박경혜,송기호,오승준,윤현구,이은직,이정민,임정수,김정희,김광준,진흥용,김대중,이경애,문성수,임동준,신동엽,김세화,권민정,김하영,김진화,김동선,김종화 대한내분비학회 2019 Endocrinology and metabolism Vol.34 No.1

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, thenumber of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements ininsurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and theKorean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment ofacromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.

Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation

이혜민,이선희,양인호,황인경,황유철,안규정,정호연,황희정,정인경 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.3

The leading cause of morbidity and mortality in patients with acromegaly is cardiovascular complications. Myocardial exposure to excessive growth hormone can cause ventricular hypertrophy, hypertension, arrhythmia, and diastolic dysfunction. However, congestive heart failure as a result of systolic dysfunction is observed only rarely in patients with acromegaly. Most cases of acromegaly exhibit high levels of serum insulin-like growth factor-1 (IGF-1). Acromegaly with normal IGF-1 levels is rare and difficult to diagnose. Here, we report a rare case of an acromegalic patient whose first clinical manifestation was severe congestive heart failure, despite normal IGF-1 levels. We diagnosed acromegaly using a glucose-loading growth hormone suppression test. Cardiac function and myocardial hypertrophy improved 6 months after transsphenoidal resection of a pituitary adenoma.

Dilated Cardiomyopathy in Acromegaly: a Case Report with Cardiac MR Findings

김민선,최혜원,서윤석,이활,박은아 대한자기공명의과학회 2019 Investigative Magnetic Resonance Imaging Vol.23 No.4

Acromegaly is a rare endocrine disorder caused by excessive secretion of the growth hormone. There is a wide range of clinical manifestations from somatic symptoms to respiratory or cardiac failure. Among them, cardiovascular involvement is a leading cause of morbidity and mortality. There are relatively few cases reporting cardiac magnetic resonance imaging (CMR) findings of cardiomyopathy in patients with acromegaly. Thus, we report a case of acromegaly showing dilated cardiomyopathy focusing on the findings of CMR.