Benfante A, Ciresi A, Bellia M, Cannizzaro F, Bellia V, Giordano C, Scichilone N
Dipartimento Biomedico di Medicina Interna e Specialistica, Sezione di Pneumologia, Università degli Studi di Palermo, via Trabucco 180, 90146, Palermo, Italy.
Lung. 2015 Jun;193(3):393-9. doi: 10.1007/s00408-015-9710-1. Epub 2015 Mar 11.
Acromegaly is an insidious disorder caused by a pituitary growth hormone (GH)-secreting adenoma resulting in high circulating levels of GH and insulin-like growth factor I (IGF-I). Respiratory disorders are common complications in acromegaly, and can severely impact on quality of life, eventually affecting mortality.
The present study aimed to explore structural and functional lung alterations of acromegalic subjects.
We enrolled 10 consecutive patients (M/F: 5/5) affected by acromegaly. In all patients, magnetic resonance imaging (MRI) revealed the presence of pituitary tumor. All patients underwent clinical, lung functional, biological, and radiological assessments. Ten healthy age-matched subjects also served as controls.
No statistically significant differences in lung function were detected between acromegalic and healthy subjects (p ≥ 0.05 for all analyses). However, the diffusing capacity for CO (TLCO) was significantly lower in the acromegalic group than in healthy subjects (TLCO% predicted: 78.1 ± 16 vs. 90 ± 6 %, respectively, p = 0.04; KCO% predicted: 77 ± 16 vs. 93 ± 5 %, p = 0.02, respectively). None of the lung function parameters correlated with duration of the disease, or with inflammatory marker of the airways. In acromegalics, biological (exhaled NO concentrations) and imaging (total lung volume, TLV, and mean lung density, MLD) evaluations were within normal values. The TLV measured by HRCT was 3540 ± 1555 ml in acromegalics, and the MLD was -711 ± 73 HU. None of the lung functional, radiological, and biological findings correlated with GH or IGF-I levels, and no correlation was found with duration of disease.
In the current study, lung function evaluation allowed to detect early involvement of lung parenchyma, as assessed by TLCO and KCO, even in the absence of parenchymal density alterations of the lung by HRCT. These findings suggest to routinely include the carbon monoxide diffusing capacity in the lung function assessment for an early intervention in acromegaly.
肢端肥大症是一种由垂体生长激素（GH）分泌性腺瘤引起的隐匿性疾病，导致循环中GH和胰岛素样生长因子I（IGF-I）水平升高。呼吸系统疾病是肢端肥大症的常见并发症，会严重影响生活质量，最终影响死亡率。
本研究旨在探讨肢端肥大症患者肺部的结构和功能改变。
我们连续纳入了10例肢端肥大症患者（男/女：5/5）。所有患者的磁共振成像（MRI）均显示存在垂体肿瘤。所有患者均接受了临床、肺功能、生物学和放射学评估。10名年龄匹配的健康受试者作为对照。
肢端肥大症患者与健康受试者的肺功能在统计学上无显著差异（所有分析中p≥0.05）。然而，肢端肥大症组的一氧化碳弥散能力（TLCO）显著低于健康受试者（预计TLCO%：分别为78.1±16和90±6%，p = 0.04；预计KCO%：分别为77±16和93±5%，p = 0.02）。肺功能参数均与疾病持续时间或气道炎症标志物无关。在肢端肥大症患者中，生物学（呼出一氧化氮浓度）和影像学（肺总量、TLV和平均肺密度、MLD）评估均在正常范围内。肢端肥大症患者经高分辨率CT（HRCT）测量的TLV为3540±1555 ml，MLD为-711±73 HU。肺功能、放射学和生物学检查结果均与GH或IGF-I水平无关，也与疾病持续时间无关。
在本研究中，肺功能评估能够检测到肺实质的早期受累情况，通过TLCO和KCO评估，即使在HRCT未显示肺实质密度改变的情况下也是如此。这些发现提示，在肢端肥大症的肺功能评估中应常规纳入一氧化碳弥散能力，以便早期干预。
