Document Detail


Treatment with growth hormone receptor antagonist in acromegaly: effect on cardiac structure and performance.
MedLine Citation:
PMID:  17105844     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: The aim of the current study was to evaluate the effect of short-term (6 months) and long-term (18 months) treatment with pegvisomant on cardiac structure and performance in patients with acromegaly. PATIENTS: Seventeen patients (nine women, eight men, 27-61 yr) with active acromegaly entered and 12 completed the long-term study. After a baseline evaluation, including measurement of hemodynamic, biochemical, and hormonal parameters, and a standard Doppler echocardiography, treatment with pegvisomant was started at the initial dose of 10 mg/d, increasing by 5 mg/d every 6 wk on the basis of IGF-I levels until normalization or the achievement of a maximal dose of 40 mg/d. RESULTS: After short-term treatment, IGF-I levels were normalized in 10 of the 17 (59%) patients. Left ventricular mass index (LVMi) was significantly decreased without changes in diastolic and systolic performance. After long-term treatment, IGF-I levels were normalized in 10 of the 12 (83%) patients. Blood glucose and serum insulin levels were decreased compared with baseline. LVMi was further decreased compared with short-term treatment, so that the prevalence of left ventricle hypertrophy decreased from 50% at baseline to 17% after 18 months of treatment. Moreover, ejection fraction as well as early to late (atrial) peak velocity ratio (E/A) were significantly increased, whereas isovolumic relaxation time was significantly decreased compared with baseline, demonstrating an improvement of both diastolic and systolic function. A significant correlation was found between the change in IGF-I levels and that of left ventricular ejection fraction. In general, the prevalence of cardiac insufficiency was present in 13 of the 17 (76%) patients at baseline and in one (8%) patient after 18 months of treatment. CONCLUSIONS: Long-term treatment with the GH receptor antagonist improves acromegalic cardiomyopathy by decreasing cardiac hypertrophy and enhancing diastolic and systolic function, and consequently partially or completely reverting the cardiac insufficiency.
Authors:
Rosario Pivonello; Maurizio Galderisi; Renata S Auriemma; Maria Cristina De Martino; Mariano Galdiero; Antonio Ciccarelli; Arcangelo D'Errico; Ione Kourides; Pia Burman; Gaetano Lombardi; Annamaria Colao
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-11-14
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  92     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-07     Completed Date:  2007-03-15     Revised Date:  2007-05-23    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  476-82     Citation Subset:  AIM; IM    
Affiliation:
Department of Molecular and Clinical Endocrinology, Federico II University of Naples, via S. Pansini 5, 80131 Naples, Italy. rpivone@tin.it
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MeSH Terms
Descriptor/Qualifier:
Acromegaly / complications,  drug therapy*
Adult
Cardiomegaly / drug therapy*,  etiology,  ultrasonography
Cardiomyopathies / drug therapy*,  etiology,  ultrasonography
Diastole / drug effects
Echocardiography, Doppler
Female
Follow-Up Studies
Human Growth Hormone / administration & dosage,  analogs & derivatives*
Humans
Insulin-Like Growth Factor I / metabolism
Male
Middle Aged
Prospective Studies
Receptors, Somatotropin / antagonists & inhibitors*
Systole / drug effects
Treatment Outcome
Chemical
Reg. No./Substance:
0/Receptors, Somatotropin; 0/pegvisomant; 12629-01-5/Human Growth Hormone; 67763-96-6/Insulin-Like Growth Factor I
Comments/Corrections
Erratum In:
J Clin Endocrinol Metab. 2007 May;92(5):1605

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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