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Departments of Endocrinology (G.K., P.J.J., J.P.M., M.G.B., A.G.) and Radiology (J.W.) St. Bartholomew’s Hospital London EC1A 7BE, United Kingdom
We were interested in the comments of Dr. Cohen regarding our recent paper on menstrual irregularity in patients with acromegaly (1). Our study was based on the clinical and endocrinological features of 47 women within the reproductive age range (18–41 yr); ultrasonographic information was not included because the number of acromegalic women who had ultrasound of the pelvis was small (15 of 175) and scattered throughout a wider age range. Cohen et al., after reviewing 25 patients in an older age range [median, 57 yr (range, 39–80 yr)], described a high prevalence of uterine leiomyomata, 81% in their series, which they attributed to a direct proliferative effect of GH or insulin-like growth factor I on the myometrium (2). It was, therefore, suggested that uterine abnormalities could be an additional factor in the menstrual irregularity seen in women with acromegaly.
We have reanalyzed the ultrasonographic data on 15 of our acromegalic women, 3 of whom were receiving estrogen replacement therapy; we found a 33% (5 of 15) prevalence of uterine leiomyomata (one of these women underwent a hysterectomy). Although our study was not designed to look specifically for the presence of uterine leiomyomata in women with acromegaly, this prevalence seems to be lower than the 81% prevalence described by Cohen et al. (2). Most importantly, the median age of our patients who underwent imaging was 44.5 yr (range, 26–50 yr), younger than those investigated by Cohen et al. (2). It is accepted that many of the complications of acromegaly are related to the duration of the disease and the time of exposure to elevated GH/insulin-like growth factor I levels [e.g. large bowel polyps are more common in older acromegalic patients (3)]. In addition, at the time of the scanning the median GH level in our women with acromegaly was 5.2 mU/L (range, 1.8–248 mU/L), and thus disease severity was less. Finally, it is probable that ultrasonographic diagnosis is less sensitive than histological examination of hysterectomy specimens: eight of the patients of Cohen et al. (2), median age 57 yr (range, 42.5–64 yr), who had ultrasound of the pelvis revealed a 62.5% prevalence of uterine leiomyomata compared to the 100% prevalence of leiomyomata in patients who underwent a hysterectomy. However, eight of our patients had a transvaginal pelvic scan, and seven patients had a transabdominal pelvic scan; transabdominal scan produces lower resolution images and has less sensitivity than the transvaginal scan, and it is possible that the prevalence of uterine leiomyomata in our patients may have been underestimated. Therefore, we agree with the message of the paper of Cohen et al. (2) that vigilance is necessary in seeking the presence of leiomyomata in women with acromegaly, particularly in the older age group.
Footnotes
Address correspondence to: Ashley B. Grossman, Department of Endocrinology, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
Received January 20, 2000.
References
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