[en] Patients with acromegaly are reported to be at risk of developing adenomatous colonic polyps, which are considered to be preneoplastic lesions. This assumption is, however, usually drawn from results obtained in rather small series of patients or without a control group. We, therefore, undertook a prospective colonoscopic and pathological study comprising 103 acromegalic patients and 138 nonacromegalic control subjects referred for irritable bowel syndrome. The prevalence of adenomatous colonic polyps was significantly increased in acromegalic patients compared to that in control subjects (22.3% vs. 8.0%; P = 0.0024). The significance was similarly present in male acromegalic patients (28.6% vs. 5.5% in male control subjects; P = 0.0026), but was absent in female acromegalic patients. The prevalence of colonic polyps was also significantly increased in the group of acromegalic patients under 55 yr of age (20.0% vs. 3.0% in the control group of the same age; P = 0.0026). Other characteristics of adenomatous colonic polyps in acromegaly were the multiplicity and the presence proximal to the splenic flexure. No difference in the duration of acromegaly was found between patients with or without adenomatous polyps. The prevalence of hyperplastic colonic polyps was also significantly increased to 24.3% in acromegalic patients vs 4.4% in control subjects (P < 0.001). In conclusion, in view of the increased incidence of adenomatous colonic polyps, colonoscopy should be part of the follow-up examination in acromegaly.
Wright AD, Hill DM, Lowly C, Fraser TR. 1970 Mortality in acromegaly. Q J Med. 39:1-16.
Bengtsson BA, Eden S, Ernest I, Oden A, Sjogren B. 1988 Epidemiology and long-term survival in acromegaly. A study of 166 cases diagnosed between 1955 and 1984. Acta Med Scand. 223:327-335.
Barzilay J, Heatley GJ, Cushing GW. 1991 Benign and malignant tumors in patients with acromegaly. Arch Intern Med. 151:1629-1632.
Capanna R, Gherlinzani F. 1981 Acromegaly associated with neoplasia. Ita! J Orthop Traumatol. 7:123-126.
Klein I, Parveen G, Gravoeler JS, Vanthiel DH. 1982 Colonic polyps in patients with acromegaly. Ann Intern Med. 97:27-30.
Ituarte EM, Petrini J, Hershman JM. 1984 Acromegaly and colon cancer. Ann Intern Med. 101:627-628.
Pines A, Rozen P, Ron E, Gilat T. 1985 Gastrointestinal tumors in acromegalic patients. Am J Gastroenterol. 80:266-269.
Ritter MM, Richter WO, Schwandt P. 1987 Acromegaly and colon cancer. Ann Intern Med. 106:636-637.
Ziel FH, Peters AL. 1988 Acromegaly and gastrointestinal adenocarcinomas. Ann Intern Med. 109:514-515.
Brunner JE, Johnson CC, Zafar S, Peterson EL, Brunner JF, Mellinger RC. 1990 Colon cancer and polyps in acromegaly: increased risk associated with family history of colon cancer. Clin Endocrinol (Oxf). 32:65-71.
Ezzat S, Strom C, Melmed S. 1991 Colon polyps in acromegaly. Ann Intern Med. 114:754-755.
Ron E, Gridley G, Hrubec Z, Page W, Arora S, Fraumeni Jr JF. 1991 Acromegaly and gastrointestinal cancer. Cancer. 68:1673-1677.
Ladas SO, Thalassinos NC, Ioannides G, Raptis SA. 1994 Does acromegaly really predispose to an increased prevalence of gastrointestinal tumours? Clin Endocrinol (Oxf). 41:597-601.
Vasen HFA, van Epercum KJ, Roelfsma F, et al. 1994 Increased prevalence of colonic adenomas in patients with acromegaly. Eur J Endocrinol. 131:235-237.
Rosen T, Bengtsson BA. 1990 Premature mortality due to cardiovascular disease in hypopituitarism. Lancet. 336:285-288.
Alexander L, Appleton O, Hall R, Ross WM, Wilkinson R. 1980 Epidemiology of acromegaly in the Newcastle region. Clin Endocrinol (Oxf). 12:71-79.
Raymond JM, Lefort G, Guerin J, et al. 1989 Significant increase in the prevalence of adenomatous colorectal polyps (ACRP) in acromegalic patients. A series of 20 patients. Gastroenterology. 5:A411.
Rex OK, Lehman GA, Hawes RH, Ulbright TM, Smith JJ. 1991 Screening colonoscopy in asymptomatic average-risk persons with negative faecal occult blood tests. Gastroenterology. 100:64-67.
Cooper H, Patchefasky AS, Marks G. 1979 Adenomatous and carcinomatous changes within hyperplastic colonic epithelium. Dis Colon Rectum. 22:152-155.
Moon HO, Simpson ME, Li CH, Evans HM. 1950 Neoplasma in rats treated with pituitary growth hormone in pulmonary and lymphatic tissues. Cancer Res. 10:297-308.
Murphy LJ, Bell GI, Friesen HG. 1987 Growth hormone stimulates sequential induction of c-myc and insulin-like growth factor I expression in vivo. Endocrinology. 120:1806-1812.
Pollack MN, Perdue JF, Margolese RG, Baer K, Richard M. 1987 Presence of somatomedin receptors on primary human breast and colon carcinomas. Cancer Lett. 38:223-230.
Smith JP, Solomon TE. 1988 Effects of gastrin, proglumide, and somatostatin on growth of human colon cancer. Gastroenterology. 95:1541-1548.
Tricoli JV, Rail LB, Karakousis CP, et al. 1986 Enhanced levels of insulin-like growth factor messenger RNA in human colon carcinomas and liposarcomas. Cancer Res. 46:6169-6173.
Cats A, Oullaart RPF, Zwart N, de Vries EGE, Hardonk MJ, Kleibeuker JH. 1993 Increased epithelial cell proliferation in the colon in patients with acromegaly. Neth J Med. 42:A3.
Herman V, Fagin J, Gonsky R, Kovacs K, Melmed SH. 1990 Clonal origin of pituitary adenomas. J. Clin Endocrinol Metab. 71:1427-1433.
Vallar L, Spada A, Giannattasio G. 1987 Altered Gs and adenylate cyclase activity in human GH-secreting pituitary adenomas. Nature. 330:566-568.
Blatt C, Eversole-Cire P, Cohn VH, et al. 1988 Chromosomal localization of genes encoding guanine nucleotide-binding protein subunits in mouse and human. Proc Natl Acad Sci USA. 85:7642-7646.
Thakker RV, Pook MA, Wooding C, Boscaro M, Scanarini M, Clayton RN. 1993 Association of somatotrophinomas with loss of alleles on chromosome 11 with gsp mutations. J Clin Invest. 92: 2815-2821.
Kinzler KW, Vogelstein B. 1992 The colorectal cancer gene hunt: current findings. Hosp Pract Off Ed. 15:51-58.
Powell SM, Zilz N, Beazer-Barclay Y, et a!. 1992 APC mutations occur early during colorectal tumorigenesis. Nature. 359:235-237.
Vogelstein B, Fearon ER, Kern SE, et al. 1989 Allelotype of colorectal carcinomas. Science. 244:207-211.
Oelattre O, Olschwang S, Law OJ, et al. 1989 Multiple genetic alterations in distal and proximal colorectal cancer. Lancet. 2:353-356.
Finlay CA, Hinds PW, Levine AJ. 1989 The p53 proto-oncogene can act as a suppressor of transformation. Cell. 57:1083-1093.
Fearon ER, Cho KR, Nigro JM, et al. 1990 Identification of a chromosome 18q gene that is altered in colorectal cancers. Science. 247: 49-56.