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Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients

Authors


Carlo Moroni, Università degli Studi di Roma, ‘La Sapienza’, Via Cogoleto 81, 00168 Roma, Italy. Fax: +39 063 051649; E-mail: carlo.moroni@uniromal.it

Abstract

OBJECTIVE Transsphenoidal surgery results in biochemical remission of acromegaly in 45–80% of patients; however, few studies have addressed the impact of transsphenoidal surgery on cardiovascular function in acromegalic patients. The aim of this prospective study was to investigate the effects of postoperative GH/IGF-I normalization on echocardiographic parameters and blood pressure (BP) in a series of patients with active acromegaly.

DESIGN An open prospective study.

PATIENTS Thirty newly diagnosed acromegalic patients undergoing transsphenoidal surgery.

MEASUREMENTS Doppler echocardiography and 24-h ambulatory blood pressure monitoring were performed before and 6 months after transsphenoidal surgery.

RESULTS Fifteen patients were considered to be well controlled postoperatively (group A), as defined by normal age-corrected IGF-I levels and glucose-suppressed GH levels less than 2 mU/l, the remaining 15 patients being considered as poorly controlled (group B). In group A, a postoperative decrease of left ventricular mass index was observed (104·4 ± 6·6 vs. 127·1 ± 7·7 g/m2; P < 0·001), associated with an improvement of some indices of diastolic function, such as an increase of the early/late transmitral peak flow velocity (P < 0·05) and a decrease of isovolumic relaxation time (P < 0·01). No significant change was observed in group B. A significant decrease of 24-h systolic BP was also observed in group A (P < 0·05) and five of six patients normalized their BP circadian rythm. In contrast, a nonsignificant increase in BP values, with a persistent blunted BP profile where present, was observed in group B.

CONCLUSIONS We conclude that successful transsphenoidal surgery is able to induce a significant improvement in some cardiac parameters and a slight reduction in systolic blood pressure in acromegalic patients.

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