Institute of Metabolic ScienceAddenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, University of Cambridge, Addenbrooke's Hospital, CB2 0QQ Cambridge, United Kingdom.
J Clin Endocrinol Metab. 2011 Jul;96(7):E1120-5. doi: 10.1210/jc.2010-2669. Epub 2011 May 4.
Several studies have suggested an increased prevalence of benign and malignant tumors in acromegaly, particularly colonic neoplasms. The gallbladder's epithelial similarity to the colon raises the possibility that gallbladder polyps (GBP) may occur more frequently in acromegaly.
Thirty-one patients with newly diagnosed acromegaly (14 females, 17 males; mean age 54.7 yr, range 27-76 yr) were referred to our center between 2004 and 2008. All had pituitary adenomas and were treated with somatostatin analogs prior to transsphenoidal surgery. Biliary ultrasonography was performed at the time of referral. In a retrospective case-cohort study, we compared the prevalence of GBP in these scans with those of 13,234 consecutive patients (age range 20-80 yr) presenting at the hospital for abdominal/biliary ultrasound during the same time interval. Associations between GH and IGF-I levels and GBP in acromegaly were also examined.
There was a higher prevalence of GBP in patients with acromegaly compared with controls (29.03 vs 4.62%, P = 0.000008); relative risk was 6.29 (95% confidence interval 3.61-10.96). Eight of nine patients with acromegaly and GBP were older than 50 yr of age. GH levels were higher in those with GBP (median 30.8 μg/liter, interquartile range 10.9-39.1) than those without (8.2 μg/liter, interquartile range 6.0-16.0), but IGF-I levels were comparable.
This is the first study to demonstrate an increased prevalence of GBP in patients with newly diagnosed acromegaly. Further studies are required to determine whether these patients are at increased risk of developing gallbladder carcinoma and to define the role, if any, of biliary ultrasound surveillance.
多项研究表明肢端肥大症患者中良性和恶性肿瘤的发病率增加，特别是结肠肿瘤。由于胆囊上皮与结肠相似，因此肢端肥大症患者胆囊息肉（GBP）的发生率可能更高。
2004 年至 2008 年间，我们中心共收治了 31 例新诊断的肢端肥大症患者（女性 14 例，男性 17 例；平均年龄 54.7 岁，范围 27-76 岁）。所有患者均患有垂体腺瘤，并在经蝶窦手术前接受了生长抑素类似物治疗。在转诊时进行了胆道超声检查。在一项回顾性病例对照研究中，我们比较了这些扫描中 GBP 的患病率与同期在医院因腹部/胆道超声就诊的 13234 例连续患者（年龄 20-80 岁）的患病率。还检查了肢端肥大症患者中 GH 和 IGF-I 水平与 GBP 之间的关系。
与对照组相比，肢端肥大症患者的 GBP 患病率更高（29.03%比 4.62%，P=0.000008）；相对风险为 6.29（95%置信区间 3.61-10.96）。肢端肥大症伴 GBP 的 9 例患者中有 8 例年龄大于 50 岁。与无 GBP 的患者相比（中位数 8.2μg/l，四分位间距 6.0-16.0），伴有 GBP 的患者的 GH 水平更高（中位数 30.8μg/l，四分位间距 10.9-39.1），但 IGF-I 水平相当。
这是第一项证明新诊断的肢端肥大症患者 GBP 患病率增加的研究。需要进一步研究以确定这些患者是否有更高的患胆囊癌风险，并确定胆道超声监测的作用（如果有的话）。
