Cancer Risk in Patients with Acromegaly: Insights from a Single Center in Ankara

TL;DR

This study finds that 21.7% of acromegaly patients had cancer, with thyroid cancer being the most common type.

Contribution

The study provides insights into cancer risk in acromegaly patients in Turkey, highlighting thyroid cancer as the most common malignancy.

Findings

21.7% of acromegaly patients had cancer, with 14.1% having thyroid cancer.

Cancer risk was not correlated with GH/IGF-1 levels or disease duration.

Thyroid cancer was the most common malignancy among Turkish acromegalic patients.

Abstract

Background: Acromegaly is a rare, chronic, systemic, and progressive disease characterized by an excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations, typically due to a macroadenoma in the pituitary gland. Both GH and IGF-1 are implicated in cancer promotion based on experimental and epidemiological data, but research findings remain conflicting and population-based data are scarce. Although there is a high mortality rate among acromegalic patients due to cardiovascular diseases, cancer is the third leading cause of death. Aim: The aim of the present study was to assess the risk of different types of cancer in acromegaly and the impact of changes in disease control and patient outcomes over time. Methods: Patients diagnosed with acromegaly at the Ankara University Ibn-i Sina Hospital Endocrinology and Metabolic Diseases Department between 2015 and 2019 were included in this study. Data including demographic data, history of cancer, size of adenoma (micro or macro), serum IGF-1 and GH levels at the time of diagnosis, serum prostate-specific antigen (PSA), thyroid ultrasonography, and, if needed, thyroid fine needle aspiration cytology (TFAC), colonoscopy, and mammography results were collected from patient records retrospectively. Results: We screened 83 patients, and 78 patients with the compensatory data (female/male: 39/39, 50%/50%) were included. The mean age of patients was 49.4 ± 11.9 years and 41.7 ± 12.1 years at the time of diagnosis. The median duration of follow-up was 72 (12–420) months. Periodic thyroid ultrasonography was performed in 65/78 (83.3%) of the patients, and a colonoscopy and mammography were also conducted in 27/78 (34.6%) and 32/39 (82%) of the patients at least once over the course of the disease, respectively. Cancer was detected in 17/78 (21.7%) of the patients; 11/78 (14.1%) of them had well-differentiated thyroid cancer and 2/39 (5.1%) had breast cancer. Prostate cancer, renal cell carcinoma, pancreatic cancer, malignant chordoma, schwannoma, and colon cancer were detected in one patient each. The increased cancer risk in acromegalic patients did not correlate with age, sex, age at diagnosis, time to diagnosing acromegaly, duration of acromegaly, GH and IGF-1 levels at diagnosis, pituitary adenoma size, or Ki-67 levels. Conclusions: Cancer was detected in 21.7% of the acromegaly patients, 14.1% of whom had well-differentiated thyroid cancer. In this study, we demonstrated that thyroid cancer is the most common malignancy in Turkish acromegalic patients, consistent with the results of previous studies. The increased cancer risk in acromegalic patients did not correlate with age, sex, age at diagnosis, time to diagnosing acromegaly, duration of acromegaly, or GH and IGF-1 levels at diagnosis.