Università degli Studi di Napoli Federico II, Department of Molecular and Clinical Endocrinology and Oncology, Via S. Pansini 5, 80131 Napoli, Italy.
Best Pract Res Clin Endocrinol Metab. 2009 Dec;23 Suppl 1:S31-8. doi: 10.1016/S1521-690X(09)70006-5.
Because growth hormone and IGF-1 both have regulatory roles in the cardiovascular system, patients with acromegaly often present with abnormalities of heart structure and function and the vascular system, which if left unmanaged can reduce life expectancy. Early symptoms of acromegalic cardiomyopathy (hyperkinetic syndrome) can be characterized by cardiac hypertrophy, increased heart rate, and increased systolic output. When left untreated, more pronounced hypertrophy, signs of diastolic dysfunction and insufficient systolic function on exertion arise, and can lead to systolic dysfunction at rest, and eventually heart failure with signs of dilative cardiomyopathy. Increasingly, evidence suggests that early diagnosis and treatment of acromegaly (before the age of 40 years) can help prevent the progression of cardiovascular disease, improve quality of life, and reduce the risk of premature mortality. This review focuses on management strategies for newly diagnosed patients with acromegaly and evidence of cardiovascular disease. The roles of surgery and medical treatment are discussed in the context of using optimal treatment strategies to help reverse cardiac hypertrophy and normalize other cardiac risk factors.
由于生长激素和 IGF-1 在心血管系统中都具有调节作用，肢端肥大症患者常伴有心脏结构和功能以及血管系统的异常，如果不加以管理，会降低预期寿命。肢端肥大性心肌病（高动力综合征）的早期症状可表现为心肌肥厚、心率加快和收缩输出增加。如果未经治疗，会出现更明显的肥厚、舒张功能障碍和运动时收缩功能不足的迹象，并可导致静息时收缩功能障碍，最终出现扩张型心肌病心力衰竭的迹象。越来越多的证据表明，早期诊断和治疗肢端肥大症（40 岁之前）有助于预防心血管疾病的进展、提高生活质量并降低过早死亡的风险。本综述重点关注新诊断为肢端肥大症且伴有心血管疾病证据的患者的管理策略。在讨论手术和药物治疗的作用时，结合了使用最佳治疗策略来帮助逆转心肌肥厚和使其他心脏危险因素正常化。
