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High Prevalence of Colonic Polyps in Patients With Acromegaly: Influence of Sex and Age

High Prevalence of Colonic Polyps in Patients With Acromegaly: Influence of Sex and Age Abstract Background: An association between acromegaly and colonic polyps has been reported, although risk factors are still uncertain. Methods: Full colonoscopy was performed with a fiberoptic colonoscope on 31 acromegalic patients, 11 men and 20 women aged 27 to 85 years (mean, 52.2 years), and on 236 subjects, 127 men and 109 women aged 23 to 84 years (mean, 50.1 years), referred for hemorrhoids, who were considered controls. The colonoscopic findings were evaluated in relation to demographic, clinical, and hormonal data pertaining to the two groups. Results: The prevalence of either adenomatous or hyperplastic polyps was higher in acromegalic patients than in controls (38% vs 14% and 26% vs 10%, respectively; P<.001, respectively). Acromegalics with and without colonic adenomas did not differ significantly in growth hormone and insulinlike growth factor I levels or duration of acromegalic disease and its status (activity or remission); however, patients with adenoma were younger (median age, 50.5 vs 59 years; range, 27 to 85 years vs 39 to 66 years; P<.05). An opposite age pattern was observed in the control group. Indeed, the prevalence of adenoma in acromegalic patients was much higher than that in controls among those less than 50 years of age (46% vs 7%, P<.001); the difference was less remarkable at older ages. Adenomatous polyps were more frequently found in male subjects, in both patients and controls (45% vs 33% [not significant] and 19% vs 9% [P<.05], respectively). Conclusions: Acromegaly may carry an increased risk of colonic adenoma, especially in younger patients, who usually display more aggressive disease. A smaller increase in risk was observed in elderly patients, in whom disease is reportedly milder. We suggest that acromegalic patients should undergo screening colonoscopy.(Arch Intern Med. 1994;154:1272-1276) References 1. Melmed S. Acromegaly . N Engl J Med. 1990;322:966-997.Crossref 2. Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly . Q `J Med. 1970;39:1-16. 3. Klein I, Parveen G, Gavaler JS, Vanthiel DH. Colonic polyps in patients with acromegaly . Ann Intern Med. 1982;97:27-30.Crossref 4. Pines A, Rosen P, Ron E, Gilat T. Gastrointestinal tumors in acromegalic patients . Am J Gastroenterol. 1985;80:266-269. 5. Ituarte EA, Petrini J, Hershman JM. Acromegaly and colon cancer . Ann Intern Med. 1984;101:627-628.Crossref 6. Brunner JE, Cole Johnson C, Zafar S, Peterson EL, Brunner JF, Mellinger RC. Colon cancer and polyps in acromegaly . Clin Endocrinol. 1990;32:65-71.Crossref 7. Ezzat S, Carey S, Melmed S. Colon polyps in acromegaly . Ann Intern Med. 1991;114:754-755.Crossref 8. Ezzat S. Hepatobiliary and gastrointestinal manifestation of acromegaly . Dig Dis. 1992;10:173-180.Crossref 9. Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk . Am J Gastroenterol. 1990;85:969-974. 10. Tappero G, Gaia E, De Giuli P, Martini S, Gubetta L, Emanuelli G. Cold snare excision of small colorectal polyps . Gastrointest Endosc. 1992;38:391-392.Crossref 11. Waye JD. Techniques of polypectomy . Am J Gastroenterol. 1987;82:615-618. 12. O'Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyps Study . Gastroenterology . 1990;98:371-379. 13. Rex DK, Lehman GA, Hawes RH, Ulbright TM, Smith JJ. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests . Gastroenterology. 1991;100:64-67. 14. Hill MJ, Morrison BC, Bussey HJR. Aetiology of adenoma-carcinoma sequence in the large bowel . Lancet. 1978;1:245-247.Crossref 15. Ezzat S, Melmed S. Are patients with acromegaly at increased risk for neoplasia? J Clin Endocrinol Metab. 1991;72:245-249.Crossref 16. Van der Lely AJ, Harris AG, Lamberts SWJ. The sensitivity of growth hormone secretion to medical treatment in acromegalic patients: influence of age and sex . Clin Endocrinol. 1992;37:181-185.Crossref 17. Murphy LJ, Bell GI, Friesen HG. Growth hormone stimulates sequential induction of c-myc and insulin-like growth factor I expression in vivo . Endocrinology. 1987;120:1806-1812.Crossref 18. Guo Y, Narayan S, Yallampalli C, Singh P. Characterization of insulin-like growth factor I in human colon cancer . Gastroenterology. 1992;102:1111-1118. 19. Culouscou JM, Shoyab M. Purification of a colon cancer cell growth inhibitor and its identification as an insulin-like growth factor binding protein . Cancer Res. 1991;51:2813-2819.n http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420110120013
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Abstract

Abstract Background: An association between acromegaly and colonic polyps has been reported, although risk factors are still uncertain. Methods: Full colonoscopy was performed with a fiberoptic colonoscope on 31 acromegalic patients, 11 men and 20 women aged 27 to 85 years (mean, 52.2 years), and on 236 subjects, 127 men and 109 women aged 23 to 84 years (mean, 50.1 years), referred for hemorrhoids, who were considered controls. The colonoscopic findings were evaluated in relation to demographic, clinical, and hormonal data pertaining to the two groups. Results: The prevalence of either adenomatous or hyperplastic polyps was higher in acromegalic patients than in controls (38% vs 14% and 26% vs 10%, respectively; P<.001, respectively). Acromegalics with and without colonic adenomas did not differ significantly in growth hormone and insulinlike growth factor I levels or duration of acromegalic disease and its status (activity or remission); however, patients with adenoma were younger (median age, 50.5 vs 59 years; range, 27 to 85 years vs 39 to 66 years; P<.05). An opposite age pattern was observed in the control group. Indeed, the prevalence of adenoma in acromegalic patients was much higher than that in controls among those less than 50 years of age (46% vs 7%, P<.001); the difference was less remarkable at older ages. Adenomatous polyps were more frequently found in male subjects, in both patients and controls (45% vs 33% [not significant] and 19% vs 9% [P<.05], respectively). Conclusions: Acromegaly may carry an increased risk of colonic adenoma, especially in younger patients, who usually display more aggressive disease. A smaller increase in risk was observed in elderly patients, in whom disease is reportedly milder. We suggest that acromegalic patients should undergo screening colonoscopy.(Arch Intern Med. 1994;154:1272-1276) References 1. Melmed S. Acromegaly . N Engl J Med. 1990;322:966-997.Crossref 2. Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly . Q `J Med. 1970;39:1-16. 3. Klein I, Parveen G, Gavaler JS, Vanthiel DH. Colonic polyps in patients with acromegaly . Ann Intern Med. 1982;97:27-30.Crossref 4. Pines A, Rosen P, Ron E, Gilat T. Gastrointestinal tumors in acromegalic patients . Am J Gastroenterol. 1985;80:266-269. 5. Ituarte EA, Petrini J, Hershman JM. Acromegaly and colon cancer . Ann Intern Med. 1984;101:627-628.Crossref 6. Brunner JE, Cole Johnson C, Zafar S, Peterson EL, Brunner JF, Mellinger RC. Colon cancer and polyps in acromegaly . Clin Endocrinol. 1990;32:65-71.Crossref 7. Ezzat S, Carey S, Melmed S. Colon polyps in acromegaly . Ann Intern Med. 1991;114:754-755.Crossref 8. Ezzat S. Hepatobiliary and gastrointestinal manifestation of acromegaly . Dig Dis. 1992;10:173-180.Crossref 9. Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk . Am J Gastroenterol. 1990;85:969-974. 10. Tappero G, Gaia E, De Giuli P, Martini S, Gubetta L, Emanuelli G. Cold snare excision of small colorectal polyps . Gastrointest Endosc. 1992;38:391-392.Crossref 11. Waye JD. Techniques of polypectomy . Am J Gastroenterol. 1987;82:615-618. 12. O'Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyps Study . Gastroenterology . 1990;98:371-379. 13. Rex DK, Lehman GA, Hawes RH, Ulbright TM, Smith JJ. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests . Gastroenterology. 1991;100:64-67. 14. Hill MJ, Morrison BC, Bussey HJR. Aetiology of adenoma-carcinoma sequence in the large bowel . Lancet. 1978;1:245-247.Crossref 15. Ezzat S, Melmed S. Are patients with acromegaly at increased risk for neoplasia? J Clin Endocrinol Metab. 1991;72:245-249.Crossref 16. Van der Lely AJ, Harris AG, Lamberts SWJ. The sensitivity of growth hormone secretion to medical treatment in acromegalic patients: influence of age and sex . Clin Endocrinol. 1992;37:181-185.Crossref 17. Murphy LJ, Bell GI, Friesen HG. Growth hormone stimulates sequential induction of c-myc and insulin-like growth factor I expression in vivo . Endocrinology. 1987;120:1806-1812.Crossref 18. Guo Y, Narayan S, Yallampalli C, Singh P. Characterization of insulin-like growth factor I in human colon cancer . Gastroenterology. 1992;102:1111-1118. 19. Culouscou JM, Shoyab M. Purification of a colon cancer cell growth inhibitor and its identification as an insulin-like growth factor binding protein . Cancer Res. 1991;51:2813-2819.n

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 13, 1994

References