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56 "Acromegaly"
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Namgok Lecture 2024
Hypothalamus and pituitary gland
Big Data Articles (National Health Insurance Service Database)
Long-Term Prognosis and Systemic Impact of Acromegaly: Analyses Utilizing Korean National Health Insurance Data
Sangmo Hong, Kyungdo Han, Cheol-Young Park
Endocrinol Metab. 2025;40(1):1-9.   Published online February 4, 2025
DOI: https://doi.org/10.3803/EnM.2024.2285
  • 10,074 View
  • 235 Download
  • 7 Web of Science
  • 11 Crossref
AbstractAbstract PDFPubReader   ePub   
Acromegaly is a rare endocrine disorder caused by excessive growth hormone secretion. Its low prevalence poses challenges in studying its long-term prognosis and systemic effects. To address this research gap, we conducted five studies using nationwide cohort data from the Korean National Health Insurance Database (NHID). This review consolidates the findings of these studies, which examined various long-term effects of acromegaly. The results demonstrated significant associations between acromegaly and increased mortality, a higher prevalence of mortality, cardiovascular outcomes, neurodegenerative diseases, depression, end-stage kidney disease, respiratory complications, specifically bronchiectasis, spine & hip fracture, and malignancy. These findings highlight the critical need for early diagnosis, comprehensive care, and long-term monitoring, and underscore the importance of a multidisciplinary approach in managing acromegaly.

Citations

Citations to this article as recorded by  
  • Growth Hormone and IGF-1 Actions in the Brain and Neuropsychiatric Diseases
    Manuel H. Aguiar-Oliveira, Margaret C. S. Boguszewski, Diego L. Rovaris, Jose Donato
    Physiology.2026; 41(1): 3.     CrossRef
  • Cardiovascular Effects of Growth Hormone: From Deficiency to Acromegaly
    Negarsadat Neshat, Parth Adrejiya, Zain Muhammad Khan, William H. Frishman, Wilbert S. Aronow
    Cardiology in Review.2026;[Epub]     CrossRef
  • Risk of cerebrovascular and cardiovascular events in acromegaly: a systematic review and meta-analysis
    Yongyan Wang, Ning Li, Yugeng Li, Jitao Zhang
    Endocrine.2026;[Epub]     CrossRef
  • Nationwide Big Data Studies of Endocrine Diseases Using the Korean National Health Information Database: Research Trends and Standardization of Operational Definitions
    Sun Wook Cho, Jung Hee Kim, Kyoung Jin Kim, Beom-Jun Kim, Mee Kyoung Kim, Eun Jung Rhee
    Endocrinology and Metabolism.2026; 41(1): 86.     CrossRef
  • Recent progress in the understanding of psychological complications of acromegaly: toward a longitudinal clinical phenotype
    Gabriella Martino, Orlando Silvestro, Francesco Ferraù, Salvatore Cannavò
    Pituitary.2026;[Epub]     CrossRef
  • Osteometabolic complications in patients with secreting pituitary adenomas: Is there an impact of gender?
    Luigi di Filippo, Matteo Acanfora, Simona Bolamperti, Umberto Terenzi, Maristella Bonomo, Andrea Giustina
    Pituitary.2026;[Epub]     CrossRef
  • Acromegaly complications: an update
    Andrea Giustina, Maria Fleseriu
    The Journal of Clinical Endocrinology & Metabolism.2026; 111(Supplement): S51.     CrossRef
  • Focus on renal morphology, chronic kidney disease, and urinary system malignancies in acromegaly: report on data collected over a 40-year period
    Polat Ercan, Busra Firlatan Yazgan, Suleyman Nahit Sendur, Seda Hanife Oguz, Selcuk Dagdelen, Tomris Erbas
    Pituitary.2026;[Epub]     CrossRef
  • Bidirectional interactions between sleep and metabolism: mechanisms and therapeutic implications for insulin resistance
    Shu-Chun Yu
    New Medicine.2025; 3(4): 238.     CrossRef
  • Spontaneous regression of a growth hormone‑secreting pituitary adenoma following thyroidectomy for toxic multinodular goiter with superior vena cava obstruction: Report of a rare case
    Bayar Qasim, Sardar Arif, Ashur Izac, Halder Abozait, Rende Kochary
    Medicine International.2025; 6(1): 1.     CrossRef
  • Why Acromegaly Dies: A Systematic Review
    Isam Noori Salman, Safaa Ehssan Atta, Baydaa Ahmed Abed, Noor Ulhuda G. Mohammed
    Maaen Journal for Medical Sciences.2025;[Epub]     CrossRef
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Original Article
Hypothalamus and pituitary gland
Obstructive Sleep Apnea Screening and Effects of Surgery in Acromegaly: A Prospective Study
Jaeyoung Cho, Jung Hee Kim, Yong Hwy Kim, Jinwoo Lee
Endocrinol Metab. 2024;39(4):641-652.   Published online June 26, 2024
DOI: https://doi.org/10.3803/EnM.2024.1933
  • 7,556 View
  • 105 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
To identify a screening tool for obstructive sleep apnea (OSA) and evaluate the effects of endoscopic transsphenoidal surgery on improving OSA in patients with acromegaly.
Methods
We prospectively enrolled adults with acromegaly scheduled for endoscopic transsphenoidal surgery. All measurements were conducted when participants were admitted for a baseline work-up for acromegaly before surgery and surveillance approximately 3 to 6 months after surgery. Respiratory event index (REI) was used as a surrogate for apnea-hypopnea index (Trial Registration: NCT03526016).
Results
Of the 35 patients with acromegaly (median age, 47 years; 40% men; median body mass index, 24.4 kg/m2), 24 (68.6%) had OSA (REI ≥5/hour), 15 (42.9%) had moderate-to-severe OSA (REI ≥15/hour). At baseline, serum insulin-like growth factor 1 (IGF-1) levels were positively correlated with the REI (ρ=0.53, P=0.001). The sensitivity and negative predictive value of a Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, age, Neck circumference, and Gender (STOP-Bang) score ≥ 3 were 93.3% and 87.5%, respectively, detecting moderate-to-severe OSA. Biochemical acromegaly remission was achieved in 32 (91.4%) patients. The median difference in the REI was –9.5/hour (95% confidence interval, –13.3 to –5.3). Half of the 24 patients diagnosed with OSA preoperatively had REI <5/hour postoperatively. In a linear mixed-effects model, changes in the REI across surgery were related to changes in IGF-1 levels.
Conclusion
The STOP-Bang questionnaire is a reliable tool for OSA among patients with acromegaly. Improvement in OSA severity after surgery is related to decreased IGF-1 levels.

Citations

Citations to this article as recorded by  
  • Change in apnea hypopnea index and sleep quality following treatment in acromegaly
    Kavita Kadian, Ravi Gupta, Rajnish Arora, Kalyani Sridharan
    Endocrine Research.2026; 51(1): 27.     CrossRef
  • Correlation between obstructive sleep apnea and pituitary function in pituitary adenomas patients
    Zitong Wang, Qi Li, Junjie Zhao, Hai Yu, Jiayi Du, Tingqin Huang, Yushan Xie, Zine Cao, Chendi Lu, Xinru Lv, Simin Zhu, Yanuo Zhou, Wei Hou, Yani Feng, Haiqin Liu, Xiaoyong Ren, Yewen Shi
    Respiratory Medicine.2026; 252: 108660.     CrossRef
  • Acromegaly and cardiovascular disease: mechanisms, clinical impact, and evolving management
    Marta Araujo-Castro, Pedro Marques, Luis Miguel Cardoso, Eider Pascual-Corrales, Julie Refardt, Sebastian J C M M Neggers, José María Jiménez Cassinello, Mónica Marazuela, Manel Puig-Domingo, Betina Biagetti
    Endocrine Reviews.2026;[Epub]     CrossRef
  • Consensus on acromegaly complications: an update
    Andrea Giustina, Luigi di Filippo, Maria Fleseriu, Rosario Pivonello, Stephan Petersenn, John Wass, Susan L. Samson, Alberto M. Pereira, Raúl M. Luque, Betina Biagetti, Maria Chiara Zatelli, Ken K Y Ho, Cesar L. Boguszewski, Aart Jan van der Lely, Mark Gu
    Pituitary.2026;[Epub]     CrossRef
  • Acromegaly complications: an update
    Andrea Giustina, Maria Fleseriu
    The Journal of Clinical Endocrinology & Metabolism.2026; 111(Supplement): S51.     CrossRef
  • Acromegaly Discovered After Head Trauma: Multivessel Coronary Disease and Postoperative Meningitis Complicating a Pituitary Macroadenoma
    Sean Rockwell, Jaxon S Boley, Nicholas Pulido, Mohammad Safa, Lila S Chertman
    Cureus.2026;[Epub]     CrossRef
  • Long-Term Prognosis and Systemic Impact of Acromegaly: Analyses Utilizing Korean National Health Insurance Data
    Sangmo Hong, Kyungdo Han, Cheol-Young Park
    Endocrinology and Metabolism.2025; 40(1): 1.     CrossRef
  • Mechanisms associated with obstructive sleep apnea in achondroplasia
    G. Dave Singh
    Journal of Clinical Sleep Medicine.2025; 21(9): 1649.     CrossRef
  • How Different Treatments for Acromegaly Modulate Sleep Quality: A Psychometric Study
    Gaspare Alfì, Danilo Menicucci, Dalì Antonia Ciampa, Vito Di Giura, Giulia Marconcini, Claudio Urbani, Fausto Bogazzi, Angelo Gemignani
    Endocrines.2024; 5(3): 408.     CrossRef
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Review Articles
Adrenal gland
The Fascinating Interplay between Growth Hormone, Insulin-Like Growth Factor-1, and Insulin
Eline C. Nijenhuis-Noort, Kirsten A. Berk, Sebastian J. C. M. M. Neggers, Aart J. van der Lely
Endocrinol Metab. 2024;39(1):83-89.   Published online January 9, 2024
DOI: https://doi.org/10.3803/EnM.2024.101
  • 165,985 View
  • 1,558 Download
  • 52 Web of Science
  • 55 Crossref
AbstractAbstract PDFPubReader   ePub   
This review intends to provide the reader with a practical overview of several (patho)physiological conditions in which knowledge of the interplay between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and insulin is important. This might help treating physicians in making the right decisions on how to intervene and improve metabolism for the benefit of patients, and to understand why and how metabolism responds in their specific cases. We will specifically address the interplay between GH, IGF-1, and insulin in type 1 and 2 diabetes mellitus, liver cirrhosis, and acromegaly as examples in which this knowledge is truly necessary.

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Close layer
Mineral, Bone & Muscle
Acromegaly and Bone: An Update
Andrea Giustina
Endocrinol Metab. 2023;38(6):655-666.   Published online December 22, 2023
DOI: https://doi.org/10.3803/EnM.2023.601
  • 17,410 View
  • 398 Download
  • 36 Web of Science
  • 39 Crossref
AbstractAbstract PDFPubReader   ePub   
Since our discovery in 2006 that acromegaly is associated with an increased risk of vertebral fractures, many authors have confirmed this finding in both cross-sectional and prospective studies. Due to the high epidemiological and clinical impact of this newly discovered comorbidity of acromegaly, this topic has progressively become more important and prominent over the years, and the pertinent literature has been enriched by new findings on the pathophysiology and treatment. The aim of this narrative review was to discuss these novel findings, integrating them with the seminal observations, in order to give the reader an updated view of how the field of acromegaly and bone is developing, from strong clinical observations to a mechanistic understanding and possible prevention and treatment.

Citations

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Close layer
Original Article
Mineral, Bone & Muscle
Big Data Articles (National Health Insurance Service Database)
Increased Risk of Hip Fracture in Patients with Acromegaly: A Nationwide Cohort Study in Korea
Jiwon Kim, Namki Hong, Jimi Choi, Ju Hyung Moon, Eui Hyun Kim, Eun Jig Lee, Sin Gon Kim, Cheol Ryong Ku
Endocrinol Metab. 2023;38(6):690-700.   Published online October 30, 2023
DOI: https://doi.org/10.3803/EnM.2023.1782
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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.

Citations

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  • Nationwide Big Data Studies of Endocrine Diseases Using the Korean National Health Information Database: Research Trends and Standardization of Operational Definitions
    Sun Wook Cho, Jung Hee Kim, Kyoung Jin Kim, Beom-Jun Kim, Mee Kyoung Kim, Eun Jung Rhee
    Endocrinology and Metabolism.2026; 41(1): 86.     CrossRef
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    Osteoporosis International.2026;[Epub]     CrossRef
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    Andrea Giustina, Luigi di Filippo, Maria Fleseriu, Rosario Pivonello, Stephan Petersenn, John Wass, Susan L. Samson, Alberto M. Pereira, Raúl M. Luque, Betina Biagetti, Maria Chiara Zatelli, Ken K Y Ho, Cesar L. Boguszewski, Aart Jan van der Lely, Mark Gu
    Pituitary.2026;[Epub]     CrossRef
  • Acromegaly complications: an update
    Andrea Giustina, Maria Fleseriu
    The Journal of Clinical Endocrinology & Metabolism.2026; 111(Supplement): S51.     CrossRef
  • Bone and joint quality remains impaired in long-term controlled acromegaly: an HR-pQCT study
    Christian Rosendal, Frederik Østergaard Klit, Annika Vestergaard Kvist, Peter Vestergaard, Jakob Dal
    Journal of the Endocrine Society.2026;[Epub]     CrossRef
  • Long-Term Prognosis and Systemic Impact of Acromegaly: Analyses Utilizing Korean National Health Insurance Data
    Sangmo Hong, Kyungdo Han, Cheol-Young Park
    Endocrinology and Metabolism.2025; 40(1): 1.     CrossRef
  • Musculoskeletal disease in acromegaly—a population-based registry study
    Christian Rosendal, Mai Christiansen Arlien-Søborg, Eigil Husted Nielsen, Claus Larsen Feltoft, Åse Krogh Rasmussen, Marianne Skovsager Andersen, Jens Otto Lunde Jørgensen, Jakob Dal
    European Journal of Endocrinology.2025; 192(3): 308.     CrossRef
  • Growth Hormone and Bone: Preclinical and Clinical Perspectives
    Kevin C.J. Yuen
    Endocrine Practice.2025; 31(9): 1197.     CrossRef
  • Bone Health in Acromegaly
    Maria Francesca Birtolo, Simona Jaafar, Giacomo Cristofolini, Gherardo Mazziotti, Andrea G. Lania
    Endocrinology and Metabolism Clinics of North America.2025; 54(4): 637.     CrossRef
  • Osteoporosis and fragility fractures in patients with acromegaly: A two-center cross-sectional study
    Mauricio Alvarez, Juliana Rincon, Maria Mercedes Ulloa, Oswaldo Rincon, Liliana Mejia, Alejandra Alvarado, Andres Pereira, Mónica Bernal
    World Journal of Orthopedics.2025;[Epub]     CrossRef
  • Novel approach to bone comorbidity in resistant acromegaly
    Stefano Frara, Matteo Acanfora, Vincenzo Franzese, Maria Luisa Brandi, Marco Losa, Andrea Giustina
    Pituitary.2024; 27(6): 813.     CrossRef
Close layer
Songwon Lecture 2022
Hypothalamus and pituitary gland
Multiomics Approach to Acromegaly: Unveiling Translational Insights for Precision Medicine
Kyungwon Kim, Cheol Ryong Ku, Eun Jig Lee
Endocrinol Metab. 2023;38(5):463-471.   Published online October 13, 2023
DOI: https://doi.org/10.3803/EnM.2023.1820
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AbstractAbstract PDFPubReader   ePub   
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.

Citations

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  • “Micromegaly”: Acromegaly with apparently normal GH, an entity on its own?
    Lucio Vilar, Luciana Ansaneli Naves, Manoel Ricardo Alves Martins, Antônio Ribeiro-Oliveira Jr
    Best Practice & Research Clinical Endocrinology & Metabolism.2024; 38(3): 101878.     CrossRef
Close layer
Original Article
Clinical Study
Associations of GNAS Mutations with Surgical Outcomes in Patients with Growth Hormone-Secreting Pituitary Adenoma
Hyein Jung, Kyungwon Kim, Daham Kim, Ju Hyung Moon, Eui Hyun Kim, Se Hoon Kim, Cheol Ryong Ku, Eun Jig Lee
Endocrinol Metab. 2021;36(2):342-350.   Published online March 23, 2021
DOI: https://doi.org/10.3803/EnM.2020.875
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AbstractAbstract PDFPubReader   ePub   
Background
The guanine nucleotide-binding protein, alpha stimulating (GNAS) gene has been associated with growth hormone (GH)-secreting pituitary adenoma. We investigated the prevalence of GNAS mutations in Korean patients with acromegaly and assessed whether mutation status correlated with biochemical or clinical characteristics.
Methods
We studied 126 patients with acromegaly who underwent surgery between 2005 and 2014 at Severance Hospital. We performed GNAS gene analysis and evaluated age, sex, hormone levels, postoperative biochemical remission, and immunohistochemical staining results of the tumor.
Results
GNAS mutations were present in 75 patients (59.5%). Patients with and without GNAS mutations showed similar age distribution and Knosp classification. The proportion of female patients was 76.5% and 48.0% in the GNAS-negative and GNAS-mutation groups, respectively (P=0.006). In immunohistochemical staining, the GNAS-mutation group showed higher GH expression in pituitary tumor tissues than the mutation-negative group (98.7% vs. 92.2%, P=0.015). Patients with GNAS mutations had higher preoperative insulin-like growth factor-1 levels (791.3 ng/mL vs. 697.0 ng/mL, P=0.045) and lower immediate postoperative basal (0.9 ng/mL vs. 1.0 ng/mL, P=0.191) and nadir GH levels (0.3 ng/mL vs. 0.6 ng/mL, P=0.012) in oral glucose tolerance tests. Finally, the GNAS-mutation group showed significantly higher surgical remission rates than the mutation-negative group, both at 1 week and 6 months after surgical resection (70.7% vs. 54.9%, P=0.011; 85.3% vs. 82.4%, P=0.007, respectively).
Conclusion
GNAS mutations in GH-secreting pituitary tumors are associated with higher preoperative insulin-like growth factor-1 levels and surgical remission rates and lower immediate postoperative nadir GH levels. Thus, GNAS mutation status can predict surgical responsiveness in patients with acromegaly.

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  • Clinical characteristics associated with somatic GNAS mutations in acromegaly: a systematic review and institutional experience
    Brendan R. Dillon, Margaret Ruddy, Emily C. McQuade, Shruti N. Shah, Alberta Twi-Yeboah, Benjamin A. Levinson, Nidhi Agrawal
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    Anat Ben-Shlomo, Shlomo Melmed
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    Claudia Ramírez-Rentería, Laura C. Hernández-Ramírez
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  • Unlocking the Genetic Secrets of Acromegaly: Exploring the Role of Genetics in a Rare Disorder
    Ioana Balinisteanu, Lavinia Caba, Andreea Florea, Roxana Popescu, Laura Florea, Maria-Christina Ungureanu, Letitia Leustean, Eusebiu Vlad Gorduza, Cristina Preda
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Close layer
Review Article
Hypothalamus and Pituitary gland
Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?
Cheol Ryong Ku, Vladimir Melnikov, Zhaoyun Zhang, Eun Jig Lee
Endocrinol Metab. 2020;35(2):206-216.   Published online June 24, 2020
DOI: https://doi.org/10.3803/EnM.2020.35.2.206
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  • 300 Download
  • 10 Web of Science
  • 10 Crossref
AbstractAbstract PDFPubReader   ePub   
Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormone elevations, 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 application of prognostic factors in medical practice, the reality of precision therapy, as well as its future prospects in acromegaly, with a special focus on its relevance to the South Korean population.

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    Luiz Eduardo Wildemberg, Aline Helen da Silva Camacho, Renan Lyra Miranda, Paula C L Elias, Nina R de Castro Musolino, Debora Nazato, Raquel Jallad, Martha K P Huayllas, Jose Italo S Mota, Tobias Almeida, Evandro Portes, Antonio Ribeiro-Oliveira, Lucio Vi
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    Florica Sandru, Adelina Popa, Dan Paduraru, Alexandru Filipescu, Mara Carsote, Adina Ghemigian
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Close layer
Original Articles
Endocrine Research
Therapeutic Effect of a Novel Chimeric Molecule Targeting Both Somatostatin and Dopamine Receptors on Growth Hormone-Secreting Pituitary Adenomas
Jean Kim, Ju Hun Oh, Heather Harlem, Michael D. Culler, Cheol Ryong Ku, Eun Jig Lee
Endocrinol Metab. 2020;35(1):177-187.   Published online March 19, 2020
DOI: https://doi.org/10.3803/EnM.2020.35.1.177
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AbstractAbstract PDFPubReader   ePub   
Background

Acromegaly is a rare disease primarily caused by growth hormone (GH)-secreting pituitary adenomas, and its treatment is costly. Moreover, some patients are unresponsive to treatment. Hence, there are increasing efforts to develop new drugs with improved effectiveness for this disease. BIM23B065 is a novel chimeric molecule that acts on both somatostatin and dopamine receptors. This study aimed to investigate the effects of BIM23B065 compared with those of a somatostatin receptor analog and a dopamine agonist.

Methods

The effects of BIM23B065 on the proliferation, GH and insulin-like growth factor-1 (IGF-1) levels, and extracellular signal-regulated kinase (ERK) 1/2 and cyclic AMP response element binding (CREB) phosphorylation of GH3 cells were investigated with MTS assay, enzyme-linked immunosorbent assay, and Western blotting, respectively. The dosage and treatment duration of BIM23B065 were tested in animal models of GH-secreting pituitary adenoma. The effect of BIM23B065 (3 mg/kg/day) on changes in IGF-1 levels before and after treatment was further investigated.

Results

In vitro, BIM23B065 treatment decreased GH release in the culture media and downregulated ERK 1/2 and CREB phosphorylation to 22% and 26%, respectively. In vivo, IGF-1 expression decreased to 50 % after 4 weeks of treatment with BIM23B065 using an osmotic pump implant. Moreover, magnetic resonance imaging results showed that the tumor size decreased significantly following treatment with BIM23B065 for 4 weeks.

Conclusion

The novel chimeric molecule was effective in decreasing IGF-1 and GH levels and may serve as an effective therapeutic agent for acromegaly.

Citations

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  • Targeting dopamine pathways with hybrid molecules: Emerging outlook for cancer treatment
    Piotr Koch, Natalia Pielaszkiewicz, Krystian Małek, Wojciech Kamysz, Patrycja Kleczkowska
    European Journal of Pharmaceutics and Biopharmaceutics.2026; 222: 115031.     CrossRef
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    Rodanthi Vamvoukaki, Maria Chrysoulaki, Grigoria Betsi, Paraskevi Xekouki
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    Nicolas Sahakian, Frédéric Castinetti, Thierry Brue, Thomas Cuny
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    Thomas Cuny, Thomas Graillon, Célines Defilles, Rakesh Datta, Shengwen Zhang, Dominique Figarella-Branger, Henry Dufour, Grégory Mougel, Thierry Brue, Tanya Landsman, Heather A. Halem, Michael D. Culler, Anne Barlier, Alexandru Saveanu
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  • Efficacy of a Novel Second-Generation Somatostatin-Dopamine Chimera (TBR-065) in Human Medullary Thyroid Cancer: A Preclinical Study
    Alessandra Dicitore, Maria Celeste Cantone, Germano Gaudenzi, Davide Saronni, Silvia Carra, Maria Orietta Borghi, Manuela Albertelli, Diego Ferone, Leo J. Hofland, Luca Persani, Giovanni Vitale
    Neuroendocrinology.2021; 111(10): 937.     CrossRef
  • Emerging drugs for the treatment of acromegaly
    Claudia Campana, Giuliana Corica, Federica Nista, Francesco Cocchiara, Giulia Graziani, Keyvan Khorrami, Marta Franco, Mara Boschetti, Diego Ferone, Federico Gatto
    Expert Opinion on Emerging Drugs.2020; 25(4): 409.     CrossRef
Close layer
A Case of Thyroid Papillary Cancer Derived from Diffuse Goiter in a Patients with Acromegaly.
Dong Hee Kim, Jick Hwa Nam, Byoung Ho Sin, Ye Kyung Seo, Jung Guk Kim, Sung Woo Ha, Bo Wan Kim, Young Ha Lee, In Su Seo
J Korean Endocr Soc. 1996;11(3):311-317.   Published online November 7, 2019
  • 1,827 View
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AbstractAbstract PDF
Patients with acromegaly have a reduced life expectancy rnainly due to cardiovascular, respiratory or cerebrovascular diseas-. Malignancy also seems to occur with greater than the expected incidence. In particular, the published retrospective or prospective studies have suggested a strong association of colonic neoplasia with acromegaly. But, there were a few reports of thyroid cancer in acrornegaly. We report a case of thyroid papillary cancer derived from diffuse goiter in acromegaly, sugge- sting the possible carcinogenic role of growth hormone.
Close layer
Relationship between Blood Pressure and Insulin Level or Red Cell Membrane Na+ Transport in Acromegaly.
Seong Yeon Kim, Hyun Kyu Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh
J Korean Endocr Soc. 1995;10(1):35-44.   Published online November 6, 2019
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  • 18 Download
AbstractAbstract PDF
To test the hypothesis that hyperinsulinemia and/or abnormalities of red cell membrane Na^+ transport are concerned in the pathogenesis of hypertension, we investigated the relationship between blood pressure, insulin level and red cell membrane Na^+ transport in patients with acromegaly which is frequently associated with hypertension, hyperinsulinemia and abnormalities of red cell membrane Na^+ transport.The results were as follows;1) BMI and both systolic and diastolic blood pressure were significantly higher in patients with acromegaly than in control subjects.2) Fasting glucose and insulin levels were higher, and both serum glucose and insulin responses after a 75g glucose load were significantly increased in patients with acromegaly as compared with control subjects.3) Vmax of Na^+-Li^+ countertransport were significantly higher in patients with acromegaly than in control subjects while red cell Na^+ concentration and Vmax of Na^+, K^+ ATPase were similar in the two groups.4) In multiple stepwise regression analysis, age was directly correlated with both systolic and diastolic blood pressure in acromegaly. On the other hand both insulin level and red cell membrane Na^+ transport showed little correlation with either systolic or diastolic pressure. 5) Prevalence of hypertension in acromegaly was 39%(9 out of 23) and only age except for blood pressure was significantly higher in hypertensive acromegalic patients than in normotensive acromegalic patients while GH level, insulin levels and red cell membrane Na^+ transport were similar in the two groupsThese results suggest that hyperinsulinemia or abnormalities of red cell membrane Na^+ transport are not causally related to hypertension in patients with acromegaly.
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Special Article
Hypothalamus and Pituitary gland
Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement
Sang Ouk Chin, Cheol Ryong Ku, Byung Joon Kim, Sung-Woon Kim, Kyeong Hye Park, Kee Ho Song, Seungjoon Oh, Hyun Koo Yoon, Eun Jig Lee, Jung Min Lee, Jung Soo Lim, Jung Hee Kim, Kwang Joon Kim, Heung Yong Jin, Dae Jung Kim, Kyung Ae Lee, Seong-Su Moon, Dong Jun Lim, Dong Yeob Shin, Se Hwa Kim, Min Jeong Kwon, Ha Young Kim, Jin Hwa Kim, Dong Sun Kim, Chong Hwa Kim
Endocrinol Metab. 2019;34(1):53-62.   Published online March 21, 2019
DOI: https://doi.org/10.3803/EnM.2019.34.1.53
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  • 370 Download
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AbstractAbstract PDFPubReader   ePub   

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance 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 the Korean 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 of acromegaly. 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.

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Close layer
Review Article
Recent Progress in the Medical Therapy of Pituitary Tumors
Fabienne Langlois, Shirley McCartney, Maria Fleseriu
Endocrinol Metab. 2017;32(2):162-170.   Published online May 19, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.162
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AbstractAbstract PDFPubReader   ePub   

Management of pituitary tumors is multidisciplinary, with medical therapy playing an increasingly important role. With the exception of prolactin-secreting tumors, surgery is still considered the first-line treatment for the majority of pituitary adenomas. However, medical/pharmacological therapy plays an important role in controlling hormone-producing pituitary adenomas, especially for patients with acromegaly and Cushing disease (CD). In the case of non-functioning pituitary adenomas (NFAs), pharmacological therapy plays a minor role, the main objective of which is to reduce tumor growth, but this role requires further studies. For pituitary carcinomas and atypical adenomas, medical therapy, including chemotherapy, acts as an adjuvant to surgery and radiation therapy, which is often required to control these aggressive tumors. In the last decade, knowledge about the pathophysiological mechanisms of various pituitary adenomas has increased, thus novel medical therapies that target specific pathways implicated in tumor synthesis and hormonal over secretion are now available. Advancement in patient selection and determination of prognostic factors has also helped to individualize therapy for patients with pituitary tumors. Improvements in biochemical and “tumor mass” disease control can positively affect patient quality of life, comorbidities and overall survival. In this review, the medical armamentarium for treating CD, acromegaly, prolactinomas, NFA, and carcinomas/aggressive atypical adenomas will be presented. Pharmacological therapies, including doses, mode of administration, efficacy, adverse effects, and use in special circumstances are provided. Medical therapies currently under clinical investigation are also briefly discussed.

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Close layer
Case Reports
Adrenal gland
Multiple Myeloma in a Patient with Acromegaly
Yu Mi Kang, Jong Han Choi, Min Jung Lee, Ari Ahn, Chan-Jeoung Park, Kiju Chang, Seyoung Seo, Sun In Hong, Min-Seon Kim
Endocrinol Metab. 2015;30(1):110-115.   Published online March 27, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.1.110
  • 11,665 View
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AbstractAbstract PDFPubReader   

Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.

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  • Hematological Malignancy in a Hypophysectomised Acromegalic Patient Under 4-Year Therapy with Somatostatin Analogues: From a Rib Lump Underlying Bone Plasmatocytoma Features to Multiple Myeloma
    Mihaela Stanciu, Alina Cătană, Ruxandra Paula Ristea, Denisa Tanasescu, Mara Carsote, Florina Ligia Popa, Ioana-Codruța Lebădă
    Diagnostics.2025; 15(20): 2623.     CrossRef
  • Co-Occurrence of Acromegaly and Hematological Disorders: A Myth or Common Pathogenic Mechanism
    Prakamya Gupta, Pinaki Dutta
    Integrative Medicine International.2017; 4(1-2): 94.     CrossRef
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Adrenal gland
Acromegaly due to a Macroinvasive Plurihormonal Pituitary Adenoma and a Rectal Carcinoid Tumor
Sang Ouk Chin, Jin-Kyung Hwang, Sang Youl Rhee, Suk Chon, Seungjoon Oh, Misu Lee, Natalia S. Pellegata, Sung-Woon Kim
Endocrinol Metab. 2015;30(3):389-394.   Published online January 5, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.3.389
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AbstractAbstract PDFPubReader   

A macroinvasive pituitary adenoma with plurihormonality usually causes acromegaly and hyperprolactinemia, and also accompanies with neurologic symptoms such as visual disturbances. However, its concurrent presentation with a rectal carcinoid tumor is rarely observed. This study reports the history, biochemical, colonoscopic and immunohistochemical results of a 48-year-old female with acromegaly and hyperprolactinemia. Despite the large size and invasive nature of the pituitary adenoma to adjacent anatomical structures, she did not complain of any neurologic symptoms such as visual disturbance or headache. Immunohistochemical staining of the surgical specimen from the pituitary adenoma revealed that the tumor cells were positive for growth hormone (GH), prolactin (PRL), and thyroid stimulating hormone (TSH). Staining for pituitary-specific transcription factor-1 (Pit-1) was shown to be strongly positive, which could have been possibly contributing to the plurihormonality of this adenoma. Colonoscopy found a rectal polyp that was identified to be a carcinoid tumor using immunohistochemical staining. A macroinvasive pituitary adenoma with concomitant rectal carcinoid tumor was secreting GH, PRL, and TSH, which were believed to be in association with over-expression of Pit-1. This is the first case report of double primary tumors comprising a plurihormonal pituitary macroadenoma and rectal carcinoid tumor.

Citations

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  • Clinical Characteristics and Management of Cosecreting Thyroid Stimulating Hormone or Prolactin Pituitary Growth Hormone Adenomas: A Case-Control Study
    Caiyan Mo, Han Chen, Jian Xu, Ying Guo, Yao Wang, Zheng Li, Tao Tong, Songbai Gui, Liyong Zhong
    Endocrine Practice.2024; 30(5): 441.     CrossRef
  • Growth Hormone Excess: Implications and Management
    Suneela Dhaneshwar, Shrishti Shandily, Vatsalya Tiwari
    Endocrine, Metabolic & Immune Disorders - Drug Targets.2023; 23(6): 748.     CrossRef
  • Pleiomorphism plurihormonal Pit-1-positive macroadenoma with central hyperthyroidism: a rare case report and literature review
    Guiliang Peng, Chuanhong Guo, Yangfan Lv, Dandan Li, Ling Zhou, Rufei Shen, Yong Chen, Xin Zheng, Zheng Sun, Hongting Zheng, Min Long
    BMC Endocrine Disorders.2022;[Epub]     CrossRef
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Original Articles
Adrenal gland
Association between the Growth Hormone Receptor Exon 3 Polymorphism and Metabolic Factors in Korean Patients with Acromegaly
Hye Yoon Park, In Ryang Hwang, Jung Bum Seo, Su Won Kim, Hyun Ae Seo, In Kyu Lee, Jung Guk Kim
Endocrinol Metab. 2015;30(3):312-317.   Published online January 5, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.3.312
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AbstractAbstract PDFPubReader   
Background

This study investigated the association between the frequency of growth hormone receptor (GHR) exon 3 polymorphism (exon 3 deletion; d3-GHR) and metabolic factors in patients with acromegaly in Korea.

Methods

DNA was extracted from the peripheral blood of 30 unrelated patients with acromegaly. GHR genotypes were evaluated by polymerase chain reaction and correlated with demographic data and laboratory parameters.

Results

No patient had the d3/d3 genotype, while four (13.3%) had the d3/fl genotype, and 26 (86.7%) had the fl/fl genotype. Body mass index (BMI) in patients with the d3/fl genotype was significantly higher than in those with the fl/fl genotype (P=0.001). Age, gender, blood pressure, insulin-like growth factor-1, growth hormone, fasting plasma glucose, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol levels showed no significant differences between the two genotypes.

Conclusion

The d3-GHR polymorphism may be associated with high BMI but not with other demographic characteristics or laboratory parameters.

Citations

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  • The Exon 3-Deleted Growth Hormone Receptor (d3GHR) Polymorphism—A Favorable Backdoor Mechanism for the GHR Function
    Ghadeer Falah, Lital Sharvit, Gil Atzmon
    International Journal of Molecular Sciences.2023; 24(18): 13908.     CrossRef
  • Gender Specificity and Local Socioeconomic Influence on Association of GHR fl/d3 Polymorphism With Growth and Metabolism in Children and Adolescents
    Xiaotian Chen, Chunlan Liu, Song Yang, Yaming Yang, Yanchun Chen, Xianghai Zhao, Weiguang Zhu, Qihui Zhao, Chuan Ni, Xiangyuan Huang, Weili Yan, Chong Shen, Harvest F. Gu
    Frontiers in Pediatrics.2022;[Epub]     CrossRef
  • Exon 3-deleted growth hormone receptor isoform is not related to worse bone mineral density or microarchitecture or to increased fracture risk in acromegaly
    J. Pontes, M. Madeira, C. H. A. Lima, L. L. Ogino, F. de Paula Paranhos Neto, L. M. C. de Mendonça, M. L. F. Farias, L. Kasuki, M. R. Gadelha
    Journal of Endocrinological Investigation.2020; 43(2): 163.     CrossRef
  • MECHANISMS IN ENDOCRINOLOGY: Lessons from growth hormone receptor gene-disrupted mice: are there benefits of endocrine defects?
    Reetobrata Basu, Yanrong Qian, John J Kopchick
    European Journal of Endocrinology.2018; 178(5): R155.     CrossRef
  • MECHANISMS IN ENDOCRINOLOGY: Clinical and pharmacogenetic aspects of the growth hormone receptor polymorphism
    Cesar L Boguszewski, Edna J L Barbosa, Per-Arne Svensson, Gudmundur Johannsson, Camilla A M Glad
    European Journal of Endocrinology.2017; 177(6): R309.     CrossRef
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Adrenal gland
Using Growth Hormone Levels to Detect Macroadenoma in Patients with Acromegaly
Ji Young Park, Jae Hyeon Kim, Sun Wook Kim, Jae Hoon Chung, Yong-Ki Min, Myung-Shik Lee, Moon-Kyu Lee, Kwang-Won Kim
Endocrinol Metab. 2014;29(4):450-456.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.450
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AbstractAbstract PDFPubReader   
Background

The aim of this study was to assess the clinical differences between acromegalic patients with microadenoma and patients with macroadenoma, and to evaluate the predictive value of growth hormone (GH) levels for early detection of macroadenoma.

Methods

We performed a retrospective analysis of 215 patients diagnosed with a GH-secreting pituitary adenoma. The patients were divided into two groups: the microadenoma group and the macroadenoma group, and the clinical parameters were compared between these two groups. The most sensitive and specific GH values for predicting macroadenoma were selected using receiver operating characteristic (ROC) curves.

Results

Compared with the microadenoma group, the macroadenoma group had a significantly younger age, higher body mass index, higher prevalence of hyperprolactinemia and hypogonadism, and a lower proportion of positive suppression to octreotide. However, there were no significant differences in the gender or in the prevalence of diabetes between the two groups. The tumor diameter was positively correlated with all GH values during the oral glucose tolerance test (OGTT). All GH values were significantly higher in the macroadenoma group than the microadenoma group. Cut-off values for GH levels at 0, 30, 60, 90, and 120 minutes for optimal discrimination between macroadenoma and microadenoma were 5.6, 5.7, 6.3, 6.0, and 5.8 ng/mL, respectively. ROC curve analysis revealed that the GH value at 30 minutes had the highest area under the curve.

Conclusion

The GH level of 5.7 ng/mL or higher at 30 minutes during OGTT could provide sufficient information to detect macroadenoma at the time of diagnosis.

Citations

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  • Growth Hormone Assay-Adjusted Standardization Reveals Distinct Clinical Phenotypes in Acromegaly
    Betina Biagetti, Pedro Marques, Roser Ferrer, Luís Miguel Cardoso, Eva Venegas Moreno, Carmen Fajardo-Montañana, Laura Gonzalez-Fernandez, Marta María Pérez Pena, Rogelio García-Centeno, Claudia Lozano-Aida, Iría Novoa-Testa, Eider Pascual-Corrales, Raúl
    Endocrine Practice.2026; 32(2): 236.     CrossRef
  • Does size really matter? A closer look at the absolute size of growth hormone-secreting pituitary adenomas
    Katharina Schilbach, Gérald Raverot
    Pituitary.2024; 27(5): 440.     CrossRef
  • Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta‐analysis of the literature
    Jakob Dal, Benedikte G. Skov, Marianne Andersen, Ulla Feldt‐Rasmussen, Claus L. Feltoft, Jesper Karmisholt, Eigil H. Nielsen, Olaf M. Dekkers, Jens Otto L. Jørgensen
    Clinical Endocrinology.2021; 94(4): 625.     CrossRef
  • Pretreatment serum GH levels and cardio-metabolic comorbidities in acromegaly; analysis of data from Iran Pituitary Tumor Registry
    Leila Hedayati Zafarghandi, Mohammad Ebrahim Khamseh, Milad Fooladgar, Shahrzad Mohseni, Mostafa Qorbani, Nahid Hashemi Madani, Mahboobeh Hemmatabadi, MohammadReza Mohajeri-Tehrani, Nooshin Shirzad
    Journal of Diabetes & Metabolic Disorders.2020; 19(1): 319.     CrossRef
  • Increased serum nesfatin-1 levels in patients with acromegaly
    Yakun Yang, Song Han, Zuocheng Yang, Pengfei Wang, Chang-Xiang Yan, Ning Liu
    Medicine.2020; 99(40): e22432.     CrossRef
  • Articles in 'Endocrinology and Metabolism' in 2014
    Won-Young Lee
    Endocrinology and Metabolism.2015; 30(1): 47.     CrossRef
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Case Report
Adrenal gland
Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation
Hyae Min Lee, Sun Hee Lee, In-Ho Yang, In Kyoung Hwang, You Cheol Hwang, Kyu Jeung Ahn, Ho Yeon Chung, Hui-Jeong Hwang, In-Kyung Jeong
Endocrinol Metab. 2015;30(3):395-401.   Published online December 9, 2014
DOI: https://doi.org/10.3803/EnM.2015.30.3.395
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AbstractAbstract PDFPubReader   

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.

Citations

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  • Acromegaly presenting with normal insulin-like growth factor-1 levels in a patient with advanced liver cirrhosis
    Ciara Kilcoyne, Kevin Burke, Michael W O’Reilly, Masood Iqbal, Mark Sherlock
    BMJ Case Reports.2026; 19(2): e266505.     CrossRef
  • A Case of Heart Failure With Reduced Ejection Fraction Secondary to Dilated Cardiomyopathy due to Long‐Standing Untreated Acromegaly: A Case Report and Focused Literature Review
    Cristian Orlando Porras Bueno, Nancy Muriel Herrera Leaño, María Juliana Soto Chávez, Darío Parra Prieto, Alejandro Mariño Correa
    Clinical Case Reports.2026;[Epub]     CrossRef
  • The effect of first intervention on cardiac parameters in patients with acromegaly: a systematic review
    Kevin A Huynh, Jin Al-Gully, José M Montero-Cabezas, Linda E Scheffers, Marco J T Verstegen, Nienke R Biermasz, Eva C Coopmans
    European Journal of Endocrinology.2025; 192(2): S1.     CrossRef
  • From Subtle Signs to Severe Sequelae—A Century of Symptomatology and Comorbidities in the Diagnosis of GH-Secreting Pituitary Neuroendocrine Tumors: A Systematic Review
    María José Ayora, Lizeth Vinueza-Mera, Santiago Aynaguano, David Poma Jimenez, Felipe Loza Hernandez, Sebastian Jara Jimenez, Jose A. Rodas, Jose E. Leon-Rojas
    Diagnostics.2025; 15(17): 2137.     CrossRef
  • Risk of Neurodegenerative Diseases in Patients With Acromegaly
    Sangmo Hong, Kyungdo Han, Kyung-Soo Kim, Cheol-Young Park
    Neurology.2022;[Epub]     CrossRef
  • Levels of Serum IGF-1, HCY, and Plasma BNP in Patients with Chronic Congestive Heart Failure and Their Relationship with Cardiac Function and Short-Term Prognosis
    Zhengyi Hu, Leifang Mao, Ling Wang, Weiguo Li
    Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1.     CrossRef
  • Neurofibromatosis Type 1 with Concurrent Multiple Endocrine Disorders: Adenomatous Goiter, Primary Hyperparathyroidism, and Acromegaly
    Shigemitsu Yasuda, Ikuo Inoue, Akira Shimada
    Internal Medicine.2021; 60(15): 2451.     CrossRef
  • Metformin stimulates IGFBP-2 gene expression through PPARalpha in diabetic states
    Hye Suk Kang, Ho-Chan Cho, Jae-Ho Lee, Goo Taeg Oh, Seung-Hoi Koo, Byung-Hyun Park, In-Kyu Lee, Hueng-Sik Choi, Dae-Kyu Song, Seung-Soon Im
    Scientific Reports.2016;[Epub]     CrossRef
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Review Article
Adrenal gland
Characteristics of Acromegaly in Korea with a Literature Review
Jae Won Hong, Cheol Ryong Ku, Sun Ho Kim, Eun Jig Lee
Endocrinol Metab. 2013;28(3):164-168.   Published online September 13, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.3.164
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AbstractAbstract PDFPubReader   

Acromegaly is a slowly progressive disease caused by excessive growth hormone (GH), which is related to a GH secreting pituitary tumor in most cases. Herein, we describe the epidemiology, clinical characteristics, and treatment of acromegaly in Korea with a literature review. The average annual incidence of acromegaly in Korea was 3.9 cases per million people, which was within the range of previous Western studies. The primary treatment for acromegaly was also transsphenoidal adenomectomy, which accounted for 90.4% of patients whose primary therapeutic options were known. The overall surgical remission rates were 89%, 87%, 64%, 70%, and 50% for modified Hardy classification I, II, IIIA, IIIB, and IV, respectively. An updated and larger study regarding the treatment outcome of medical/radiotherapy in Korean acromegalic patients is needed.

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  • Automatic acromegaly detection using deep learning on hand images: a multicenter observational study
    Yuka Ohmachi, Mizuho Nishio, Ichiro Abe, Kunihisa Kobayashi, Tomoko Iida, Manabu Shirakawa, Yuichi Nagata, Kazuhito Takeuchi, Akira Taguchi, Yasuyuki Kinoshita, Noriaki Fukuhara, Hiroshi Nishioka, Shigeyuki Tahara, Shingo Fujio, Takafumi Ogura, Masamichi
    The Journal of Clinical Endocrinology & Metabolism.2026; 111(8): e1994.     CrossRef
  • Risk of depression in patients with acromegaly in Korea (2006-2016): a nationwide population-based study
    Shinje Moon, Sangmo Hong, Kyungdo Han, Cheol-Young Park
    European Journal of Endocrinology.2023; 189(3): 363.     CrossRef
  • Increased Risk of Hip Fracture in Patients with Acromegaly: A Nationwide Cohort Study in Korea
    Jiwon Kim, Namki Hong, Jimi Choi, Ju Hyung Moon, Eui Hyun Kim, Eun Jig Lee, Sin Gon Kim, Cheol Ryong Ku
    Endocrinology and Metabolism.2023; 38(6): 690.     CrossRef
  • Selective screening of patients with associated somatic diseases as a method of early detection of acromegaly
    M. B. Antsiferov, V. S. Pronin, T. M. Alekseeva, O. A. Ionova, E. Y. Martynova, Yu. E. Poteshkin, N. A. Chubrova, K. Y. Zherebchikova
    Problems of Endocrinology.2021; 67(1): 20.     CrossRef
  • Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?
    Cheol Ryong Ku, Vladimir Melnikov, Zhaoyun Zhang, Eun Jig Lee
    Endocrinology and Metabolism.2020; 35(2): 206.     CrossRef
  • Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study
    Xiaopeng Guo, Kailu Wang, Siyue Yu, Lu Gao, Zihao Wang, Huijuan Zhu, Bing Xing, Shuyang Zhang, Dong Dong
    Frontiers in Endocrinology.2020;[Epub]     CrossRef
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    Enrique López Gavilanez, Kempis Guerrero Franco, Narcisa Solórzano Zambrano, Manuel Navarro Chávez, Camilo López Estrella, Luis Vaca Burbano, Eduardo Marriott Díaz
    Endocrinología y Nutrición.2016; 63(7): 333.     CrossRef
  • A magnetic resonance imaging‐based classification system for indication of trans‐sphenoidal hypophysectomy in canine pituitary‐dependent hypercortisolism
    A. Sato, T. Teshima, H. Ishino, Y. Harada, T. Yogo, N. Kanno, D. Hasegawa, Y. Hara
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  • Epidemiology of acromegaly in Ecuador
    Enrique López Gavilanez, Kempis Guerrero Franco, Narcisa Solórzano Zambrano, Manuel Navarro Chávez, Camilo López Estrella, Luis Vaca Burbano, Eduardo Marriott Díaz
    Endocrinología y Nutrición (English Edition).2016; 63(7): 333.     CrossRef
  • An Association Study Between Gene Polymorphisms of Folic Acid Metabolism Enzymes and Biochemical and Hormonal Parameters in Acromegaly
    Aslı Tetik Vardarlı, Ayhan Zengi, Vildan Bozok Çetintaş, Muammer Karadeniz, Sadık Tamsel, Ali Şahin Küçükaslan, Timur Köse, Füsun Saygılı, Zuhal Eroglu
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    Ferdinand Roelfsema, Gerrit van den Berg
    Expert Review of Endocrinology & Metabolism.2015; 10(6): 619.     CrossRef
  • Change in quality of life in patients with acromegaly after treatment with octreotide LAR: first application of AcroQoL in Korea
    Sang Ouk Chin, Choon Hee Chung, Yoon-Sok Chung, Byung-Joon Kim, Hee Young Kim, In-Ju Kim, Jung Guk Kim, Min-Seon Kim, Seong-Yeon Kim, Eun Jig Lee, Ki Young Lee, Sung-Woon Kim
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    Won-Young Lee
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Case Reports
A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor.
Wonjin Kim, Jung Ho Kim, Youngsook Kim, Ji Hye Huh, Su Jin Lee, Mi Sung Park, Eun Yeong Choe, Jeong Kyung Park, Myung Won Lee, Jae Won Hong, Byung Wan Lee, Eun Seok Kang, Bong Soo Cha, Eun Jig Lee, Hyun Chul Lee
Endocrinol Metab. 2012;27(4):318-322.   Published online December 20, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.4.318
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AbstractAbstract PDF
Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.
Close layer
Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature.
Jung Hee Koh, Yong Jae Lee, Ji Hyun Kang, Bo Kwang Choi, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Joo Kim
Endocrinol Metab. 2012;27(4):308-313.   Published online December 20, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.4.308
  • 3,972 View
  • 33 Download
  • 2 Crossref
AbstractAbstract PDF
We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic resonance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pancytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case.

Citations

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  • A 24-Year-Old Male with Gigantism, Growth Hormone Deficiency, Suspected Clivus Chordoma, Primary Hypothyroidism, Hypogonadism and Pancytopenia
    W.A. Arsana, M.I. Diah Pramudianti
    INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY.2019; 26(2): 249.     CrossRef
  • Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma
    Dianna Lang, Jennifer S. Mead, David B. Sykes
    Journal of General Internal Medicine.2015; 30(5): 692.     CrossRef
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The Effect of Octreotide LAR on GH and TSH Co-Secreting Pituitary Adenoma.
Nam Keong Kim, Yu Jin Hah, Ho Young Lee, Sang Jin Kim, Mi Kyung Kim, Keun Gyu Park, Ealmaan Kim, Hyukwon Chang, Hye Soon Kim
Endocrinol Metab. 2010;25(4):378-381.   Published online December 1, 2010
DOI: https://doi.org/10.3803/EnM.2010.25.4.378
  • 3,091 View
  • 32 Download
AbstractAbstract PDF
Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5% for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1microg/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.
Close layer
Sustained Maintenance of Normal Insulin-like Growth Factor-I during Pregnancy and Successful Delivery in an Acromegalic Patient with Octreotide-LAR(R) Treatment.
Soo Kyoung Kim, Jung Hwa Jung, Jae Hyeon Kim, Kyu Yeon Hur, Alice Hyun Tan, Hee Kyung Kim, Ji In Lee, Hye Soo Chung, Kwang Won Kim
Endocrinol Metab. 2010;25(3):213-216.   Published online September 1, 2010
DOI: https://doi.org/10.3803/EnM.2010.25.3.213
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  • 23 Download
AbstractAbstract PDF
We report here on a 34-year-old Korean woman with active acromegaly and who received Octreotide-LAR(R) for 12 months following transsphenoidal pituitary surgery. During Octreotide-LAR(R) treatment, the clinical improvement was paralleled with the decrease of the growth hormone levels to 1.1 ng/mL and the insulin-like growth factor-I (IGF-I) levels to 345.5 ng/mL. Octreotide-LAR(R) was discontinued when the patient was found to be at the 12th week of pregnancy. During pregnancy, the patient experienced clinical well-being and she maintained her IGF-I levels within the normal range for her age-matched despite discontinuation of Octreotide-LAR(R) treatment at early gestation. She delivered a full-term healthy male infant. The serum IGF-I levels of the patient increased progressively increased after delivery. This report describes a successful pregnancy in an acromegalic woman who was exposed to Octreotide-LAR(R) during the early gestational period. She and who showed an unexpected pattern of persistently normal IGF-I levels through the pregnancy despite discontinuation of Octreotide-LAR(R) therapy.
Close layer
Acromegaly with Diabetes Insipidus after Pituitary Tumor Removal: Successful Pregnancy and Delivery.
Sei Hyun Kim, Joo Il Kim, Yae Min Park, In Sik Won, Kwen Chul Shin, Yunjeong Jo, Sihoon Lee, Yeun Sun Kim, Ki Young Lee, Ie Byung Park
J Korean Endocr Soc. 2010;25(1):56-60.   Published online March 1, 2010
DOI: https://doi.org/10.3803/jkes.2010.25.1.56
  • 3,463 View
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AbstractAbstract PDF
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.
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Original Articles
Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients.
Seul young Kim, Dohee Kim
J Korean Endocr Soc. 2010;25(1):37-45.   Published online March 1, 2010
DOI: https://doi.org/10.3803/jkes.2010.25.1.37
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  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
Somatostatin analogues have been used as the first-line medical therapy for active acromegaly that is not completely cured, or which recurs after surgery. The aim of this study was to compare the effects of octreotide long-acting repeatable (LAR) and lanreotide Autogel. Such a comparison has not been reported in Korea. METHODS: Twenty-seven patients who had previously undergone surgery for acromegaly from December 2003 to March 2005 were included. We retrospectively investigated eight patients who underwent operation only and 19 patients who additionally received medical treatment after surgery (octreotide LAR, n = 5; lanreotide Autogel, n = 5). Growth hormone (GH) and insulin-like growth factor-I (IGF-I) levels were measured. RESULTS: The mean pre-operative and post-operative levels of GH were lower in patients who underwent surgery only than in those who received adjuvant therapy, but IGF-I levels were not significantly different. In the 19 patients receiving medical treatment after unsuccessful surgery, the mean baseline GH levels were 24.2 microgram/L for octreotide LAR and 22.8 microgram/L for lanreotide Autogel (P = 0.711), and the mean GH levels 36 months post-treatment were 4.1 microgram/L and 2.5 microgram/L, respectively (P = 0.794). GH < 2.5 microgram/L represented 30% of octreotide LAR patients and 33.3% of lanreotide Autogel patients (P = 0.91). Patients with normal IGF-I levels represented 54.5% and 66.7%, respectively (P = 0.71). CONCLUSION: No significant difference in therapeutic effect of octreotide LAR and lanreotide Autogel was evident in 19 Korean acromegalic patients who were not completely cured by surgery and radiation therapy.

Citations

Citations to this article as recorded by  
  • Pharmacoeconomic analysis of lanreotide and prolonged-release octreotide in first- and second-line therapy of acromegaly
    I. S. Krysanov, E. V. Makarova, V. Yu. Ermakova, D. V. Kurkin
    FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology.2025; 18(1): 22.     CrossRef
  • Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement
    Sang Ouk Chin, Cheol Ryong Ku, Byung Joon Kim, Sung-Woon Kim, Kyeong Hye Park, Kee Ho Song, Seungjoon Oh, Hyun Koo Yoon, Eun Jig Lee, Jung Min Lee, Jung Soo Lim, Jung Hee Kim, Kwang Joon Kim, Heung Yong Jin, Dae Jung Kim, Kyung Ae Lee, Seong-Su Moon, Dong
    Endocrinology and Metabolism.2019; 34(1): 53.     CrossRef
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Discrepancy between the Growth Hormone and Insulin-like Growth Factor-I Concentrations in Patients with Acromegaly.
Ji Won Yoon, Mi Yeon Kang, Hwa Young Ahn, Jee Hyun An, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Bo Youn Cho, Hong Kyu Lee, Seong Yeon Kim
J Korean Endocr Soc. 2008;23(6):395-403.   Published online December 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.6.395
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BACKGROUND
This study was performed to evaluate the frequency and clinical characteristics of patients with active acromegaly and who show discordance of the growth hormone (GH) level and the insulin-like growth factor-I (IGF-I) level. METHODS: We reviewed the medical records of the patients who were diagnosed with acromegaly between 01/01/1995 and 6/30/2007 at Seoul National University Hospital. We selected only the patients whose basal GH and IGF-I levels were available. We investigated the pre- and post-operative clinical characteristics, as well as the blood concentrations of GH and IGF-I. The concordance rate between the two hormones was examined. The patients were considered to have active disease on the basis of their IGF-I levels above the normal range, after adjustment for age and gender, and their mean basal GH value was > or = 2.5 microgram/L. The hormone levels and the clinical parameters were compared between the hormone concordant and discordant groups. RESULTS: We reviewed the preoperative records of 103 acromegalic patients, and these patients met the above-mentioned criteria. 53 postoperative patients who were not cured by operation were monitored without them receiving radiation or medical therapy. Both the basal GH and IGF-I levels were above normal in 103 patients preoperatively, and the discordant rate was 0% (0/103 cases). Postoperatively, the discordant rate between the two hormones was increased to 30.2% (16/53 cases). Age, gender, body mass index and tumor size were insignificantly different between the concordant and discordant groups. However, postoperative residual tumors were less frequently observed in the discordant group (P = 0.006). CONCLUSION: For the patients with acromegaly, unlike the 0% discordance preoperatively, 30.2% of patients showed a discrepancy between their GH and IGF-I levels postoperatively. The patients who had hormonal discrepancy were less likely to have residual tumors after operation. Considering the frequency of this hormonal discrepancy, both hormone levels should be measured to evaluate the disease activity after treatment. Further, oral glucose tolerance testing should be performed and especially for the patients with an increased GH level, but who have a normal IGF-I concentration.
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Case Reports
Two Cases of Acromegaly with Empty Sella Syndrome Treated by Long-Acting Release Octreotide.
Dong Jin Kim, Young Jin Seo, Nam Hoon Kim, Hye Soo Chung, Chai Ryoung Eun, Hye Jung Choi, Hye Sook Kim, Sae Jeong Yang, Juri Park, Hye Jin Yoo, Soo Yeon Park, Yun Jeong Lee, Ohk Hyun Ryu, Kye Won Lee, Hee Young Kim, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi
J Korean Endocr Soc. 2007;22(2):135-141.   Published online April 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.2.135
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Two cases of typical acromegaly with empty sella syndrome presented to our institution. In the natural course of untreated pituitary adenoma, empty sella syndrome may result from necrosis by infarction or from hemorrhage of the pituitary gland. In our patients, the secretion of growth hormone continued in spite of the existence of empty sella syndrome. In one case, we confirmed the hypersecretion of growth hormone from sella by jugular vein sampling. Medical therapy with somatostatin analogue was attempted because there was no obvious mass in the sella. After 6~12 months of treatment with long-acting release octreotide, clinical features in our patients were improved, and the level of growth hormone and IGF-1 were also normalized.
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Two Cases of Acromegaly with Empty Sella.
Hyun Sun Cho, Tae Seo Sohn, So Young Lee, Kyoung Hee Kim, Yu Kyung Park, Jung Min Lee, Hyun Shik Son
J Korean Endocr Soc. 2006;21(6):572-576.   Published online December 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.6.572
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An empty sella may develop as a consequence of a primary congenital weakness of the diaphragm for which no secondary cause is evident. A secondary empty sella may develop after infarction of a pituitary adenoma or because of surgical or radiation-induced damage to the sellar diaphragm. Acromegaly is caused by growth hormone (GH) hypersecretion and the resultant elevated levels of circulating insulin like growth factor-1. The underlying abnormality in more than 98% of cases is hypersecretion of GH by a pituitary GH-producing tumor. Necrosis and hemorrhage, which frequently occur in pituitary adenomas, may lead to complete or partial disappearance of the adenoma, and subsequently, to an empty sella. We report two cases of acromegaly with empty sella, and the patients had no symptoms of pituitary apoplexy.
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A Case of Idiopathic Myelofibrosis Associated with Acromegaly Patient.
Jun Young Song, Pyoung Rak Choi, Hong Jun You, Seong Hoon Shin, Yu Ri Kim, Young Sik Choi, Yo Han Park, Mi Hyang Kim, Bong Kwon Chun, Young Duk Joh
J Korean Endocr Soc. 2006;21(4):328-332.   Published online August 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.4.328
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AbstractAbstract PDF
Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
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A Case of Pituitary Mucormycosis in Diabetic Patient with Acromegaly and Gastric Cancer.
Pyoung Rak Choi, Hong Jun Yu, Seung Wu Yang, Gyu Jong Kim, Hark Rim, Yu Ri Kim, Young Sik Choi, Yo Han Park, Bong Kwon Chun
J Korean Endocr Soc. 2006;21(3):245-250.   Published online June 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.3.245
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AbstractAbstract PDF
Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, acute, and aggressive fungal infection occurring in several immunocompromised states including poorly controlled diabetes. ROCM causes a very high residual morbidity and mortality due to the angioinvasion property of the fungus. Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone, generally from pituitary adenoma. Although it has been demonstrated that acromegalic patients have an increased risk of neoplasm, gastric cancer with acromegaly is very rare. We experienced a case of pituitary mucormycosis in the diabetic patient with acromegaly and gastric cancer. The patient was treated successfully with subtotal gastrectomy for early gastric cancer, transsphenoidal surgery for pituitary adenoma, and a systemic application of amphotericin B for the mucormycosis.

Citations

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  • Optimization of ethanol extraction and further purification of isoflavones from soybean sprout cotyledon
    Seung Yong Cho, Yu Nam Lee, Hyun Jin Park
    Food Chemistry.2009; 117(2): 312.     CrossRef
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A Case of Early Gastric Cancer Coincidentally Developed in a Patient with Acromegaly.
Kyun Woo Park, So Young Lee, Hye Suk Son, Yi Sun Jang, Hye Soo Kim, Jong Min Lee, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang
J Korean Endocr Soc. 2006;21(2):165-169.   Published online April 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.2.165
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AbstractAbstract PDF
Acromegaly is associated with an increased risk for a variety of cancers such as colon cancer, prostate cancer and breast cancer. However, there have been few reports of gastric cancer developing in an acromegaly patient. A 66-year-old man suffered with diabetes mellitus and hypertension for 15 years, and he visited the endocrinology department due to dizziness. On physical examination, the biochemical studies and the sella MRI, he showed the typical features of acromegaly with pituitary microadenoma. During the cancer screening studies to find the cause of anemia, early gastric cancer was diagnosed by pathologic examination of the tissue biopsies. We described the summary of characteristics of the patient and reviewed literature.
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A Case of Iodine-induced Thyrotoxicosis with Acromegaly.
Kwang Hyun Kim, Kyu Hong Kim, Ho Yoel Ryu, Su Min Nam, Mi Young Lee, Jang Hyun Koh, Jang Yeol Sin, Choon Hee Chung
J Korean Endocr Soc. 2006;21(1):63-67.   Published online February 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.1.63
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AbstractAbstract PDF
Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma.
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A Case of Acromegaly Caused by Double Pituitary Adenomas.
Hai Jin Kim, Chul Sik Kim, Jong Suk Park, Jina Park, Jee Hyun Kong, Ji Sun Nam, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Soon Won Hong
J Korean Endocr Soc. 2006;21(1):53-57.   Published online February 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.1.53
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AbstractAbstract PDF
Acromegaly is a clinical syndrome, which is caused by an excess of growth hormone (GH), most commonly secreted from a pituitary solitary adenoma. However, our patient had bilateral GH-secreting pituitary tumors, the incidence of which has been reported in only 1.3 to 1.69% of all acromegalic patients. A 59-year-old female, with no family history of pituitary adenomas, demonstrated an increased level of serum insulin-like growth factor-1 (IGF-1), and GH not suppressed after 75 g oral glucose loading. On a preoperative MRI, only one pituitary tumor, measuring 1.1 x 0.7 cm, could be observed using sellar MRI. After surgical resection of the tumor, her headache and myalgia were sustained, and the IGF-1 level was still in a high titer. Therefore, a follow-up sellar MRI was taken, and a 0.6 x 0.7 cm sized newly growing pituitary tumor was found on the other side. With a retrospective review of radiological examinations, the patient was found to have bilateral tumors. The 0.3 cm sized tumor on the left was too small to be detected on the preoperative MRI. As the patient preferred medical treatment after surgery, she was treated with sandostatin analogues. Acromegaly with bilateral GH-secreting pituitary tumors, is a very rare disease, with no previous case having been reported in Korea. Herein, we report the case with a review of the literature.
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A Case of Acromegaly with Gall Bladder Cancer.
Ji Sun Nam, Chul Sik Kim, Jee Hyun Kong, Hai Jin Kim, Jin A Park, Jong Suk Park, Chul Woo Ahn, Se Joon Lee, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee
J Korean Endocr Soc. 2005;20(4):401-406.   Published online August 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.4.401
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AbstractAbstract PDF
Acromegaly is a systemic endocrine disorder due to an excessive release of growth hormone, which increases the serum levels of insulin-like growth factor-1(IGF-1). Elevated levels of these hormones are assumed to increase the incidence of malignant tumors in patients with acromegaly, due to by stimulating the growth and maturation of cells. In particular, IGF-1 is considered to be closely related with the development of colon polyps and colon cancers. Studies suggest that various malignant tumors, including thyroid cancer, brain tumor and renal cell carcinomas, are also more common in patients with acromegaly. Here, a case of gall bladder cancer in a patient with acromegaly, and the possible relationships between these two disorders, is reported.
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Original Article
Efficacy of Octreotide LAR in Acromegalic Patients.
Ji Youn Kim, Jae Hwan Jee, Chan Ho Yoon, Yun Jae Chung, Byung Wan Lee, Gun Yong Cho, Sang Young Kim, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim
J Korean Endocr Soc. 2005;20(4):344-352.   Published online August 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.4.344
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  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
Octreotide(OC)-LAR is a long-acting preparation of octreotide which has been effectively used to suppress GH/IGF-1 hypersecretion in acromegalic patients. The clinical response, biochemical outcomes, and safety of OC-LAR were evaluated in 27 active acromegalic patients. METHOD: 27patients with an active disease status (according to the clinical picture, GH >5microgram/L and elevated age-matched IGF-1), and previously treated with bromocriptine after surgery, comprised the study population. OC-LAR was given(20mg, i.m., every 4 week for 3 injections, then the doses were titrated individually) and the acromegalic symptoms and adverse reactions recorded. The serum levels of GH and IGF-1 were evaluated every 12 week. The acromegalic symptoms including headache, fatigue and arthralgia, improved in all patients. RESULTS: Gastrointestinal side effects were transient and mild. The levels of GH significantly decreased, from 8.9+/-3.5 to 2.9+/-2.2 microgram/L at 12 weeks(P<0.001, vs. baseline), to 2.9+/-2.1microgram/L after 24 weeks(P<0.001) and to 2.5 +/-1.3microgram/L at 48 weeks(P<0.001). The levels of IGF-1 significantly decreased, from 753.7+/-213.6 to 429.7+/-253.4 microgram/L at 12 weeks(P<0.001, vs. at baseline), to 405.7+/-213.3microgram/L at 24 weeks(P <0.001) and to 348.9+/-144.7microgram/L at 48 weeks(P<0.001). The safelevel of GH is less than 2.5microgram/L and normal age-matched IGF-1 levels were achieved in 63 and 52% of the patients, respectively. CONCLUSION: Octreotide-LAR was well tolerated and effective as an adjuvant treatment in lowering the levels of GH and IGF-1 in active acromegalic patients.

Citations

Citations to this article as recorded by  
  • Letter: Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients (J Korean Endocr Soc 25:37-45, 2010)
    Yu-Bae Ahn
    Endocrinology and Metabolism.2010; 25(2): 157.     CrossRef
  • The Effect of Octreotide LAR on GH and TSH Co-Secreting Pituitary Adenoma
    Nam Keong Kim, Yu Jin Hah, Ho Young Lee, Sang Jin Kim, Mi Kyung Kim, Keun Gyu Park, Ealmaan Kim, Hyukwon Chang, Hye Soon Kim
    Endocrinology and Metabolism.2010; 25(4): 378.     CrossRef
  • Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients
    Seul young Kim, Dohee Kim
    Journal of Korean Endocrine Society.2010; 25(1): 37.     CrossRef
  • Response: Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients (J Korean Endocr Soc 25:37-45, 2010)
    Seul Young Kim, Dohee Kim
    Endocrinology and Metabolism.2010; 25(2): 159.     CrossRef
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Case Reports
A Case of Isolated Familial Somatotropinoma.
Hwi Ra Park, Eun A Kim, Mei Hua Jiang, Chang Soo Jang, Kyoung Wook Lee, Seong Bin Hong, Eun Young Kim, Myung Kwan Lim, Moon Suk Nam, Yong Seong Kim
J Korean Endocr Soc. 2004;19(4):398-405.   Published online August 1, 2004
  • 1,770 View
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AbstractAbstract PDF
The familial occurrence of a pituitary adenoma associated with multiple endocrine neoplasia (MEN) type 1 or Carney complex is a well-recognized entity. However, an isolated familial somatotropinoma is a rare inherited disease, which is characterized by clustering of a somatotrophic adenoma and acromegaly or gigantism in a family, but without other manifestations of MEN type 1, with only 68 cases, in 28 families, described in the literature. The mode of inheritance is autosomal dominant, with incomplete penetration, but the genetic background of these pituitary adenomas remains unknown. A family exists where both the father and son were affected. Endocrinological investigations confirmed hypersecretion of GH and IGF-1, and the pituitary adenomas were identified by magnetic resonance image in both cases. There was no symptom of MEN type 1 or other form of endocrine dysfunction. Herein is reported a case of an isolated familial somatotropinoma in Korea, with a review of the literature
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Diabetic Ketoacidosis in a Patient with Acromegaly.
Eun Hee Koh, Min Kyung Kim, Jin Tae Park, Il Seong Nam-Goong, Joong Yeol Park, Ki Up Lee, Min Seon Kim
J Korean Endocr Soc. 2004;19(4):393-398.   Published online August 1, 2004
  • 1,949 View
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AbstractAbstract PDF
Acromegaly is a chronic, debilitating condition caused by excessive secretion of growth hormone (GH). Impaired glucose tolerance is present in about 20-40% of acromegaly, with diabetes mellitus developing in about 10~15% of patients, but diabetic ketoacidosis is a rare association. Herein is reported a case of diabetic ketoacidosis in a 33 year-old female, with a 4 year history of typical acromegaly features. She presented with severe hyperglycemia and ketoacidosis, but with no other cause for this metabolic derangement. She had elevated plasma GH (50 ng/mL) and IGF-1 (1533 ng/mL) levels, and a pituitary macroadenoma. About 200 units of insulin per day were required for her glycemic control. However, the serum IGF-1 level and daily insulin requirement were significantly tapered after a transsphenoidal adenomectomy and long acting somatostatin analogue treatment. There was a good correlation with the daily insulin requirement and plasma IGF-1 level. This case demonstrates that severe GH excess can cause diabetic ketoacidosis, and that its successful treatment improves glucose metabolism.
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Original Articles
Gene Expression of the Somatostatin Receptors, Gi2 alpha and Pit-1 alpha in GH3 Cells Permanently Transfected with a Mutant Gs alpha Gene.
Cheol young Park, In myung Yang, Eun hee Kim, Sook jin Sohn, Mee sook Ryu, Jeong taek Woo, Sung woon Kim, Jin woo Kim, Young seol Kim, Young kil Choi, Seung joon Park
J Korean Endocr Soc. 2002;17(2):170-182.   Published online April 1, 2002
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AbstractAbstract PDF
BACKGROUND
Cyclic AMP stimulates the expression of the somatostatin (SRIF) receptor (sst1-5) and human growth hormone (GH)-secreting pituitary tumors with the gsp oncogene which increases intracellular cAMP levels, and shows a good inhibitory response of the GH to SRIF. Taken together, we hypothesized that the gsp oncogene may increase the SRIF receptor expression or and factors related to the postreceptor signal transduction of the SRIF, in order to enhance its responsiveness to SRIF. To test this hypothesis, we investigated if the gsp oncogene could increase the sst1, sst2, Gi2 alpha, and pit-1 alpha gene expression in GH3 cells. METHODS: GH3 cells were permanently transfected with the plasmid expressing Gs alpha gene, where the arginine of codon 201 was replaced with histidine. Intracellular cAMP levels and GH concentrations were measured by radioimmunoassays. Gene expressions of the sst1, sst2, Gi2 alpha, and pit-1 alpha were determined by RT-PCR. RESULTS: Intracellular cAMP levels and medium GH release were increased by 1.7 and 2.7-fold in GH3 cells expressing the gsp oncogene, respectively. In GH3 cells expressing the gsp oncogene, the sst1 mRNA levels were decreased, whereas those of the sst2, Gi2 alpha and pit-1 alpha mRNA were increased. A 4-h forskolin (10 M) stimulation remarkably increased the sst1 and sst2 mRNA levels in GH3 cells expressing wild and mutant Gs alpha . However, forskolin did not affect the Gi2 alpha and pit-1 alpha mRNA levels. In contrast, SRIF (1 M, 2 h) decreased the sst2 mRNA levels only in GH3 cells expressing the gsp oncogene. CONCLUSION: These results suggest that higher expressions of sst2, Gi2 alpha, and pit-1 alpha, induced by the gsp oncogene may be a mechanism by which gsp-positive pituitary tumors show a greater response to SRIF. The discrepancy between these and in vivo results should be explored further.
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Gene Expression of Somatostatin Receptor (Subtype 2 & 5), Gi2 alpha and Pit-1 in GH-secreting Pituitary Adenomas.
Mee sook Ryu, In myung Yang, Cheol young Park, Jeong taek Woo, Sung woon Kim, Jin Woo Kim, Young seoul Kim, Young kil Choi, En hee Kim, Seung joon Park, Kook gi Kim
J Korean Endocr Soc. 2002;17(2):158-169.   Published online April 1, 2002
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AbstractAbstract PDF
BACKGROUND
Mutation of Gs protein subunit (gsp oncogene), detected in about 30~40% of growth hormone (GH)-secreting pituitary tumors, is associated with an increased long-acting somatostatin analog octreotide sensitivity. However, the mRNA expression of somatostatin receptor (sst) was not changed in the GH-secreting pituitary tumor, regardless of whether they were gsp oncogene positive or negative. This suggests that the expression of genes coding for Gi2 alpha , Pit-1 and the other factors involved in the regulation of secretory activity in somatotrophs is likely to be altered in gsp oncogene positive tumors. We observed the impact of the gsp oncogene on the expression of the genes coding for Gi2 alpha, Pit-1 and sst (2&5) in GH-secreting pituitary tumors. METHODS: The GH response to octreotide was examined in 13 acromegalic patients before transsphenoidal adenomectomy. Genomic DNA and RNA were extracted from fresh frozen tumor tissues. PCR was performed to amplify and sequence the region between codon 184 and 251 that includes exons 8 and 9 of the Gs gene. Sst2, sst5, Gi2 alpha and Pit-1 mRNA levels were measured by semi-quantitative RT-PCR. RESULTS: Sst2 and sst5 mRNA transcripts were detected in all tumors (7 gsp +, 6 gsp-). The amount of sst transcripts varied considerably varied between the tumors. There were no significant differences in sex, age, tumor size, grade or basal GH levels. Pit-1 and sst2 mRNA levels were not different. In contrast, Gi2 alpha mRNA levels were significantly higher in gsp (+) while sst5 mRNA levels were higher in gsp (-). CONCLUSION: These data suggests that gsp oncogene may increase Gi2 alpha levels but decrease sst5 mRNA levels. However, Pit-1 and sst2 mRNA expression may not be affected by gsp oncogene. The increased expression of the Gi2 alpha gene might be an inhibitory compensatory response to the action of gsp oncogene.
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Case Reports
A Case of Acromegaly with Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis .
Choon Young Lee, Moon Kyu Lee, Sun Young Lee, Sung No Hong, Hyung Hoon Kim, Bo Hyun Kang, Han Wook Kang, Byung Wan Lee, Yu Jeong Park, Yong Ki Min, Myung Shik Lee, Kwang Won Kim, Jong Hyun Kim
J Korean Endocr Soc. 2002;17(1):110-116.   Published online February 1, 2002
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AbstractAbstract PDF
Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 mg/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70~110 mg/dL, 13~100 U/L and 13~190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 mg/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 cm sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis
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A Case of Acromegaly with Graves' Disease.
Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Jong Hyun Kim, Eun Young Oh, Yun Jae Chung, Sang Soo Bae
J Korean Endocr Soc. 1998;13(3):432-438.   Published online January 1, 2001
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Goiter is present in 25-50% of patients with acromegaly, which probably results from IGF- I stimulation of thyroid cell growth. These goiters are usually non-toxic but there have been well documented cases of co-existent hyperthyroidism and acromegaly. Graves disease with acromegaly has been rarely reported compared with the other type of hyperthyroidism due to increased tumoral secretion of TSH. We experienced a 44-year-old woman who presented with Graves disease and acromegaly. Basal serum GH and IGF-I concentrations were 10.8 pg/L and 571.82 ng/mL, respectively (reference value: (5 mg/L and 130-354 ng/mL, respectively). GH was not suppressed less than 2 pg/L during oral glucose loading test. GH was stimulated by TRH. Postcontrast sellar MRI demonstrated ovoid-shaped low signal intensity nodule measuring O.8 cm in diameter in left side of pituitary gland. Thyroid scan(131I) showed enlarged thyroid with increased radioiodine uptake (61.3%). Histologic examination showed acidophilic adenoma. GH and prolactin were positive on immunohistochemical staining. GH was suppressed less than 2.26 mg/L by oral glucose loading following operation. The patient has been followed with antithyroid drug(PTU) medication after operation(TSA).
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A Case of Acromegaly Caused by Mixed Gangliocytoma-Adenoma of the Pituitary Gland.
Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yeon Rim Seo, Jong Hyun Kim, Sang Jong Park
J Korean Endocr Soc. 1998;13(3):423-431.   Published online January 1, 2001
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The tumors containing ganglion cells are rare in the pituitary gland. These tumors are divided into two groups. The first group is the cases of mixed gangliocytoma-adenoma that contained both gangliocytoma and pituitary adenoma elements in the same tumor and the second group is those of gangliocytoma that contained only gangliocytoma element. Since the first description by Kiyono in 1926, 45 cases have been reported. The most common presentation of these tumors is acromegaly and the cases of Cushings disease and galactorrhea-amenorrhea also have been reported. In immunohistochemical study, hypothalamic-releasing hormones are stained in gangliocytoma cells and adenohypophyseal hormones are stained in adenoma cells. The releasing hormones stained in gangliocytoma element and the pituitary hormones stained in adenoma elements are usually closely related but unrelated cases also have been reported. We report a case of a 41 year-old lady with acromegaly which was diagnosed as mixed gangliocytoma-adenoma after surgical removal of the pituitary tumor.
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Original Articles
Comparison of Immunohistochemical and Clinical Characteristics in Pituitary Adenoma with Acromegaly.
Jae Hoon Chung, Eun Mi Koh, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yeon Rim Seo, Dong Kyu Na, Jong Hyun Kim, Kyu Jeong Ahn, Jin Seok Kim
J Korean Endocr Soc. 1998;13(3):324-330.   Published online January 1, 2001
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BACKGROUND
It assumed that plurihormonal pituitary adenomas in acromegaly, which were immunohistochemically stained with other pituitary hormones in addition to GH and prolactin, would be originated from poorly differentiated cells. Therefore, we speculated that they might have higher growth rates and worse prognosis than monohormonal adenomas. To verify this speculation, we analyzed the frequency of plurihormonal adenomas and compared the clinical parameters and radiological invasiveness between plurihormonal adenoma and GH-prolactin adenoma in acromegaly. METHODS: We studied 38 patients with acromegaly (22 males and 16 females, mean age 40.7 years) who were underwent surgical removal of pituitary adenomas by TSA from January 1995 to February 1998. We performed immunohistochemical staining in these tumors using avidinbiotin peroxidase complex method. An adenoma was considered as immunoreactive when above 50 percents of tumor cells were stained with anti-hormonal antibodies. Invasiveness of tumors were evaluated by preoperative MRI findings on the basis of Hardys classification. RESULTS: The frequencies of plurihormonal and GH-prolactin adenomas were 42% and 58%, respectively. Plurihormonal adenoma included an adenoma which was not stained with prolactin, but with GH and other hormones. Prolactin immunoreactivity was found in 97%(37/38) of the tumors. Immunoreactivities to FSH, ACTH, LH, and TSH were found in 37.8%, 13.1%, 2.6% and 2.7%, respectively. There were no significant differences in age, basal serum GH and IGF-1 concentrations between plurihormonal and GH-prolactin adenomas. There were also no significant differences in response to TRH & LH stimulation tests and somatostatin & bromocriptine suppression tests between two groups. There were no differences in radiological invasiveness between two groups (plurihormonal adenoma, grade I 2, grade II 3, grade III 7, grade IV 4; GH-prolactin adenoma, grade I 3, grade II 6, grade III 9, grade IV 4). CONCLUSION: Plurihormonal adenomas were 44% and immunoreactivity to prolactin was 97% in pituitary adenomas in acromegaly. There were no significant differences in clinical parameters and radiological invasiveness between plurihormonal and GH-prolactin adenomas in acromegaly.
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Outcome of Surgery and Radiotherapy in Acromegaly.
Chan Soo Shin, Chang Hoon Yim, Hee Won Jung, Dae Hee Han, Do Joon Park, Hee Jin Kim, Yun Yong Lee, Kyung Soo Park, Il Han Kim, Sung Yeon Kim, Hong Gyu Lee
J Korean Endocr Soc. 1998;13(2):156-166.   Published online January 1, 2001
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BACKGROUND
The primary goal of therapy for acmmegaly is to reduce excess growth hormone (GH) secretion through surgical excision of pituitary adenoma and, in patients with large tumors, to debulk tumor mass and decompress adjacent structures. For the patients in whom surgery is contraindicated or has failed, radiotherapy should be considered. However, there was no analysis of the outcome folIowing the treatment of acromegly in Korea. METHODS: We retrospectively reviewed 128 patients who underwent surgical excision or radiotherapy for acromegaly and followed at our hospital between January 1980 and July 1997 to investigate the outcome of surgny and radiotherapy for acromegaly and to analyze preoperative and preradiotherapeutic parameters that predict a successful outcome of therapy. RESULTS: Pituitary adenomectomy was underwent to the 113 patients with acromegaly, then 33.6% of them showed basa1 GH levels below 5 ug/L and basal GH levels were dropped below 2.5 ug/L in 22.1% of the 113 patients. Postoperative basal GH levels were significantly correlated with preoperative tumor size(r=0.54, p<0.05) and preoperative GH levels(r=0.44, p<0.05). A successful outcome of surgery was influenced by preoperative tumor size, preoperative GH level and extrasellar extension. Multivariate analysis indicated that preoperative tumor size was an independent significant factor affecting the postoperative outcome(OR=2.19, p<0.05). After radiotherapy, the median years of decrease GH<10ug/L and <5ug/L were 3.7 and 7.8, respectively and GH levels of <5ug/L occurred in 35 percent of the patients at 5 years and in 56 percent at 10 yeats. The outcome of radiotherapy depends on the GH levels in preradiotherapy. CONCLUSION: The most reliable prognostic preoperative parameter of successful outcome of surgery was preoperative tumor size and the rate of fall in serum GH after radiotherapy is comparable to the preradiotherapy GH levels in our study, so that early diagnosis and proper treatment can improve the outcome of therapy in the patients with acromegaly. In the cases of large GH-secreting pituitary adenoma, it is required a combination of surgery and radiotherapy to achieve maximal suppresssion of GH levels before radiotherapy.
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Case Reports
A Case of McCunt-Albright Syndrome Associated with Acremegaly and Fibrous Dysplasia.
Jung Guk Kim, Sung Woo Ha, Sang Won Chung, Seong Mo Koo, Jae Tae Lee, Kyu Bo Lee, Yong Sun Kim, Sam Kwon, Bo Wan Kim
J Korean Endocr Soc. 1998;13(1):108-114.   Published online January 1, 2001
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Acromegaly and hyperprolactinemia have been described in association with polyostotic fibrous dysplasia. The pathogenic mechanisms of this endocrinopathy are not clear. We experienced a 19-year-old male with hypersecretion of GH, hyperprolactinemia and fibrous dysplasia. He was referred for evaluation of suspected acromegaly. He had no skin pigmentation. Plasma GH, PRL, somatomedin-C, LH, FSH, testosterone, estradiol, progesterone, T3, T4, TSH and cortisol were measured. Among those, the levels of plasma GH, PRL and somatomedin-C were high. Serum alkaline phosphatase was increased. OGTT did not suppress plasma OH concentration and GH showed paradoxical response to TRH and LHRH. GH was suppressed after a test-dose of somatastatin and bromocriptine. Brain MRI demonstrated a mass lesion in sella turcica and another mass lesions in nasal cavity and posterior occipital bone. Whole body bone scan revealed increased uptake in skull, nasal bone, both 9th posterior rib, both femurs, both tibias, left scapular and pelvic bone. These fmdings were consistent with bone tumor such as fibrous dysplasia. We report a case with incomplete MeCune-Albright syndrome including acromegaly, hyperprolactinemia and polyostotic fibrous dysplasia.
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A Case of Carney Complex.
Sung Kil Lim, Bong Soo Cha, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Kyung Rae Kim, Young Joon Won, Suk Ho Kwon, Ru Tha Lee, Bo Young Chung, Kwang Kil Lee
J Korean Endocr Soc. 1997;12(4):633-641.   Published online January 1, 2001
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Carney Complex is an autosomal dominant syndrome characterized by multiple neoplasias, including myxomas at various sites and endocrine tumors, spotty pigmentations and schwannomas. The criteria for diagnosis of the complex is the presence of two or more of the following conditions: 1) cardiac myxoma, 2) cutaneous myxoma, 3) mammary myxoma, 4) spotty mucocutaneous pigmentation, 5) primary pigmented nodular adrenal cortical disease (Cushing's syndrome), 6) testicular tumors (sexual precocity), 7) pituitary adenoma secreting growth hormone (acromegaly or gigantism). It is thought that the genetic defects which are responsible for Carney complex maps to the short arm of chromosome 2 (2p16). There are about 200 patients with Carney complex reported in the world. We encounted a patient who had a cardiac myxoma with a family history of cardiac myxoma, acromegaly, lentigosis, testicular mass with calcification and left adrenal nodule. This patient met the criteria for the diagnosis of the complex. Therefore, we think this patient represents clinical presentation of the Carney complex and we report this case with reviews of the literatures.
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Original Articles
Gene Expression of Somatostatin Receptor Subtype 2 and 5 in GH-Secreting Pituitary Adenomas.
Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Young Kil Choi, Seung Joon Park, In Myoung Yang, Jung Taek Woo, Kook Ki Kim
J Korean Endocr Soc. 1997;12(4):508-517.   Published online January 1, 2001
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BACKGROUND
SSTR2 and SSTR5 are most frequently observed in GH-secreting pituitary tumors, and SSTR5 is believed to be more specific to mammosomatotroph lineage. Octreotide binds with high affinity to those two types. There is no report that investigates the quantitative comparison of the two subtype gene expressions, and the correlation between their gene expressions and GH response to octreotide in GH-secreting pituitary adenomas. METHOD: GH response to octreotide was examined in 8 acromegalic patients before transsphenoidal adenomectomy. Genomic DNA and RNA were prepared from fresh frozen tumor tissues. PCR was performed to amplify and sequence the region between codon 184 and 251 that includes exons 8 and 9 of the Gas gene. mRNAs of SSTR2 and SSTRS were quantitated by the comparative RT-PCR and in vitro transcription. RESULTS: The in vitro transcripts of SSTR2 and SSTR5 cDNA were detected in all tumors. The amount of SSTR transcripts was considerably variable between the tumors. The amount of SSTR5 transcript was significantly smaller than that of SSTR2 transcript (0.07+-0.02 vs. 0.87+-0.10), and they did not show any correlation . There was no signicant difference in sex, age, tumor size and grade, basal GH levels, and the GH responses to octreotide between the group with high and low SSTR gene expression. No significant correlation was found between the GH response to octreotide and the amount of SSTR2 transcript, wherease the amount of SSTR5 transcripts showed a tendency of negative correlation with the octreotide response. Tumors with gsp oncogene showed significantly higher response to octreotide than those without the oncogene. The amount of SSTRS transcript in gsp-positive tumors was significantly smaller than in gsp-negative tumors (0.03+-0.01 vs. 0.12+-0.03). CONCLUSION: These results suggest that SSTRS gene expression is lower than that of SSTR2 in GH-secreting adenomas. It is probably attributed to the binding of somatostatin to SSTR5 which has a higher affinity to the hypothalamic somatostatin, Tumors with gsp-oncogene is likely to express a higher density of SSTR5 than those without the oncogene.
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Expression of TRH Receptor Gene in GH-Secreting Piruitary Adenomas.
In Myung Yang, Seung Joon Park, Jeong Wha Ryu, Joo Ho Chung, Mee Sook Ryu, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Young Kil Choi
J Korean Endocr Soc. 1997;12(3):349-356.   Published online January 1, 2001
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Background
To test the hypothesis that Galphas gene mutation may suppress the expression of TRH-R gene, we investigated whether hTRH-R gene expression is lower in human GH-secreting pituitary adenomas with Galphas mutation than in tumors without the mutation. Method: TRH-induced paradoxical response of GH was observed in 8 acromegalic patients. The mutation of gene was identified by direct sequencing of the genomic DNA prepared from GH-secreting pituitary adenomas. The expression of hTRHT mRNA was quantitated by RT-PCR. Results: The transcript of hTRH-R gene was detected in 6 of 8(75%) tumors. Three of these(50%) showed the paradoxical GH response to TRH and the other three patients did not show the response. The relative expression of hTRH-R mRNA in the tumors from patients with the paradoxical response of GH to TRH did not differ from that in the tumors from patients without the paradoxical response. Direct PCR sequencing of Galphas disclosed a mutant allele and a normal allele only at codon 201 in 4 of 8 tumors. The paradoxical response to TRH was observed in 2 of 4 patients without the mutation, and 2 of 4 patients with the mutation. The hTRH-R gene expression of pituitary adenomas did not differ between the tumors without the mutation and those with mutation. Conclusion: This study suggests that the expression of TRH-R gene is not likely to be a main determinant for the paradoxical response of GH to TRH, and that Galphas mutation does not seem to suppress the gene expression of TRH-R in GH secreting adenoma.
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Thyrotropin-releasing Hormone(TRH) Receptor Gene Expression in GH3 Cells Permanently Transfected with a Mutant Gs alpha Gene.
Seung Joon Park, In Myung Yang, Sung Vin Yim, Joo Ho Chung, Jee Chang Jung, Kye Chang Ko, Young Seol Kim, Young Kil Choi
J Korean Endocr Soc. 2000;15(1):46-54.   Published online January 1, 2001
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BACKGROUND
Gs alpha gene mutation, that constitutively increases intracellular cAMP, is found in some acromegalic patients. It was demonstrated that increased intracellular cAMP levels suppress the expression of rat TRH receptor (TRH-R) mRNA. We previously demonstrated that transient expression of a mutant Gs alpha gene suppress the rat TRH-R gene expression in the cultured rat growth hormone-secreting tumor cell line (GH3), whereas TRH-R gene expression in adenomas with Gs alpha gene mutation (gsp oncogene) did not differ from that in tumors without the mutation. The discrepancy suggests the possibilities that the effect of permanent expression of mutant Gs alpha gene on TRH-R gene expression is different from that of transient expression of the mutant gene and hypothalamic hormones including TRH regulate the gene expression. METHODS: We investigated whether permanent expression of the mutant-type Gs alpha does not suppress the TRH receptor gene expression in GH3 cells, and whether TRH suppresses the gene expression by using reverse transcription-polymerase chain reaction (RT-PCR) and in vitro transcription. RESULTS: Permanent expression of a mutant-type Gs alpha increased basal cAMP levels up to 1.7-fold relative to the controls, whereas the wild-type cell line did not show increased cAMP levels. Permanent expression of a mutant-type Gs alpha increased TRH receptor mRNA level up to 2.8 fold compared with the controls. Treatment of the permanently transfected GH3 cells with TRH suppressed TRH-R gene expression more prominently compared to the wild type GH3 cells. CONCLUSION: These results suggest that permanent expression of mutant Gs alpha enhances the expression of TRH-R in GH-secreting pituitary tumors with gsp oncogene, but the gene expression may also be regulated by other factors including TRH.
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Bone Turnover and Bone Mineral Density in Acromegaly.
Sun Wook Kim, Hee Jin Kim, Seon Hwa Lee, Won Bae Kim, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 1999;14(4):688-697.   Published online January 1, 2001
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BACKGROUND
Abnormalities of calcium homeostasis and bone remodelling were known in acromegaly, but controversy concerning the influence of chronically elevated serum growth hormone (GH)/insulin like growth factor-I (IGF-I) concentrations on bone metabolism has been existed. In this study, we assess the effect of chronically elevated serum GH/IGF-I levels on bone metabolism and bone mineral density (BMD) in patients with acromegaly and compare the markers of bone metabolism and BMD of active acromegaly according to gonadal function. METHODS: We measured biochemical markers of bone turnover and BMD in 50 acromegalic patients (41 active disease, 9 inactive disease) and 41 control subjects. RESULTS: Active acromegalic patients had significantly higher serum oteocalcin levels (13.8+/-7.7 versus 6.8+/-4.7, 6.0+/--3.4 ng/mL, p<0.05) and urinary type I cross-linked N-telopeptide (101.7+/-64.2 versus 49.3+/-33.3, 56.1+/-39.4 nM BCM/mM Cr, p<0.05) compared with inactive acromegaly and control subjects. Serum IGF-I levels correlated positively with serum osteocalcin levels(r=0.69, p<0.05) and urinary type I cross-linked N-telopeptide (r=0.44, p<0.05). In the female patients with active acromegaly, BMD (T-score) was elevated in the femoral neck(1.00+/-0.14 versus 0.89+/-0.12,p<0.05) and trochanter (0.88+/-0.15 versus 0.77+/-0.11, p<0.05), whereas BMD of lumbar spine(1.13+/- 0.17 versus 1.17+/-0.17, p>0.05) and femoral Ward's triangle (0.78+/-0.16 versus 0.77+0.13, p>0.05) were not different from those of control subjects. In the patients with active acromegaly, serum osteocalcin levels (16.4+/-8.8 versus 14.9+/-10.1 ng/mL, p>0.05) as well as urinary type I cross-linked N-telopeptide (104.8+/-68.1 versus 122.0+/-80.3 nM BCM/mM Cr, p>0.05) were not different according to gonadal function. Also, femoral and spinal BMD were not different according to the gonadal function. CONCLUSION: GH/IGF-I excess increase bone turnover and might achieve a positive bone balance at each remodelling cycle. Markers of bone turnover and BMD of skeletal bone were not influenced by gonadal function in the patients with active acromegaly.
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Endocrinol Metab : Endocrinology and Metabolism
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