Acromegaly, inflammation and cardiovascular disease: a review
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Acromegaly, inflammation and cardiovascular disease: a review Thalijn L. C. Wolters 1 & Mihai G. Netea 1,2 Romana T. Netea-Maier 1
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Niels P. Riksen 1
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Adrianus R. M. M. Hermus 1
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# The Author(s) 2020
Abstract Acromegaly is characterized by Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) excess. Uncontrolled acromegaly is associated with a strongly increased risk of cardiovascular disease (CVD), and numerous cardiovascular risk factors remain present after remission. GH and IGF-1 have numerous effects on the immune and cardiovascular system. Since endothelial damage and systemic inflammation are strongly linked to the development of CVD, and have been suggested to be present in both controlled as uncontrolled acromegaly, they may explain the presence of both micro- and macrovascular dysfunction in these patients. In addition, these changes seem to be only partially reversible after remission, as illustrated by the often reported presence of endothelial dysfunction and microvascular damage in controlled acromegaly. Previous studies suggest that insulin resistance, oxidative stress, and endothelial dysfunction are involved in the development of CVD in acromegaly. Not surprisingly, these processes are associated with systemic inflammation and respond to GH/IGF-1 normalizing treatment. Keywords Inflammation . Insulin-like growth Factor-1 . Cardiovascular disease . Acromegaly . Growth hormone . Cytokines
1 Introduction Acromegaly is caused by excessive growth hormone (GH) secretion, generally by a pituitary adenoma, and concomitant Insulin-like Growth Factor 1 (IGF-1) excess. [1, 2]. GH and IGF-1 excess exerts many actions on the cardiovascular (CV) system, and CV comorbidities and disease (CVD) risk factors are common, especially in active acromegaly [3–5], but often persist after adequate treatment in patients with controlled disease [6–9]. Circulating IGF-1 inhibits GH secretion via direct negative feedback on the pituitary and also indirectly via stimulating hypothalamic somatostatin secretion [10]. IGF-1 has multiple systemic, autocrine, and paracrine effects, that are specific for the tissues, cellular pathways and metabolic circumstances in which they take place [11]. In addition,
* Thalijn L. C. Wolters [email protected] 1
Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA Nijmegen, The Netherlands
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Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
the GH and IGF-1/insulin signaling pathways share certain downstream elements, which facilitate the crosstalk between these pathways [11]. The interaction with other hormones and growth factors modulate the effects of IGF-1 [12]. The management of acromegaly and its associated comorbidities has improved over the last decades, resulting in a decreased incidence of macrovascular events. Some more contemporary studies reported the incidence of these macrovascular complications in patients with cont
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