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Submitted on February 10, 2004
Accepted on October 15, 2004
Dipartimento di Scienze Cliniche e Biologiche, Clinica Medica, Università di Torino (M Terzolo MD, G Reimondo MD, F Daffara MD, E Gaia MD, A Angeli MD), Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università Federico II di Napoli (R Pivonello MD, G Vitale MD, G Lombardi MD, A Colao MD), Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, Università di Pisa (M Gasperi MD, E Cecconi MD, E Martino MD), Divisione di Endocrinologia, Ospedale Niguarda, Milano (R Cozzi MD, R Attanasio MD), Divisione e Unità di Ricerca di Endocrinologia, Istituto Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo (A Scillitani, MD), Italy
* To whom correspondence should be addressed.
Massimo Terzolo, E-mail: terzolo{at}usa.net
Background: Acromegaly is an infrequent disease attributable to endogenous excess of growth hormone (GH) and insulin-like growth factor I (IGF-I). Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a problem or not in acromegaly is currently unresolved. We performed a cross-sectional study to assess the risk of colonic neoplasia in patients with acromegaly.
Methods: Colonoscopic screening was performed in 235 patients with acromegaly at 5 tertiary care hospitals in Italy between January 1, 1996 and December 31, 2001. A repeat colonoscopy was performed in 121 patients after a mean interval of 32.1 months. Colonoscopic findings in patients with acromegaly were compared with those of 233 patients with non-specific abdominal complaints who were referred for endoscopy during the study period.
Results: A total of 65 patients (27.7%) and 36 controls (15.5%) had colonic neoplasia. In 55 patients (23.4%) and 34 control subjects (14.6%), the most important findings were adenomas (odds ratio: 1.7, 1.1-2.5), while 10 patients (4.3%) and 2 control subjects (0.9%) had carcinoma (odds ratio: 4.9, 1.1-22.4). The risk of colonic neoplasia was higher for younger patients with acromegaly compared with age-matched controls. Patients with acromegaly with or without colonic neoplasia did not differ significantly for IGF-I levels or duration of disease. A neoplastic recurrence was found in 16.5% of patients who underwent follow-up; 90% of them had had a neoplasm removed at the first colonoscopy.
Conclusions: Acromegaly carries with it a moderate but definitive increase in the risk of colonic neoplasia that occurs at a younger age than in general population. Patients who are found to harbor a colonic neoplasia are at risk for recurrence.
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