Early Lung Function Abnormalities in Acromegaly
Early Lung Function Abnormalities in Acromegaly
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DOI：
10.1007/s00408-015-9710-1
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发表时间：
2015-06-01
期刊：
影响因子：
5
通讯作者：
Scichilone, N.
中科院分区：
文献类型：
--
作者：
Benfante, A.;Ciresi, A.;Scichilone, N.
肢端肥大症是一种由垂体生长激素（GH）分泌腺瘤引起的隐性疾病，导致高循环水平的GH和胰岛素样生长因子I（IGF-I）。呼吸系统疾病是肢端肥大症的常见并发症，严重影响患者的生活质量，最终影响死亡率。本研究旨在探讨肢端肥大症患者的肺结构和功能改变。我们连续入选了10例肢端肥大症患者（男/女：5/5）。在所有患者中，磁共振成像（MRI）显示垂体瘤的存在。所有患者均接受了临床、肺功能、生物学和放射学评估。肢端肥大症患者和健康人的肺功能在统计学上没有显著差异（所有分析的p <0.05）。然而，肢端肥大症组的CO弥散量（TLCO）显著低于健康受试者（TLCO%预测值：分别为78.1 +/- A 16 vs. 90 +/- A 6%，p = 0.04; KCO%预测值：分别为77 +/- A 16 vs. 93 +/- A 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（呼出的NO浓度）和成像（总肺体积，TLV和平均肺密度，MLD）评价均在正常值范围内。在肢端肥大症患者中，通过HRCT测量的TLV为3540 +/- A 1555 ml，MLD为-711 +/- A 73 HU。肺功能，放射学和生物学研究结果与GH或IGF-I水平无关，与病程无相关性，在目前的研究中，肺功能评估允许检测肺实质的早期受累，通过TLCO和KCO评估，即使在没有肺实质密度改变的情况下，通过HRCT。这些发现提示，在肢端肥大症的早期干预中，肺功能评估应常规包括一氧化碳弥散量。
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 a parts per thousand yen 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 +/- A 16 vs. 90 +/- A 6 %, respectively, p = 0.04; KCO% predicted: 77 +/- A 16 vs. 93 +/- A 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 +/- A 1555 ml in acromegalics, and the MLD was -711 +/- A 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.