Acromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications.

2.50
Hdl Handle:
http://hdl.handle.net/10541/78935
Title:
Acromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications.
Authors:
Renehan, Andrew G; O'Connell, J; O'Halloran, Domhnall J; Shanahan, F; Potten, Christopher S; O'Dwyer, Sarah T; Shalet, Stephen M
Abstract:
Acromegaly is an endocrine disorder characterised by sustained hypersecretion of growth hormone (GH) with concomitant elevation of insulin-like growth factor (IGF)-I, and is associated with malignancy and premature mortality from cardiovascular and respiratory diseases. In particular, there may be an increased risk of colorectal neoplasia, but the exact extent of this is contentious. Colonoscopy-based studies of adenoma prevalence rates in acromegalic patients are misleading, but population-based studies on colorectal cancer risk are more consistent - a meta-analysis estimated a pooled risk ratio of 2.04 (95 % CI: 1.32, 3.14). Possible mechanisms underlying this increased risk include direct actions as a consequence of elevated levels of circulating GH and IGF-I and/or other perturbations within the IGF system. Other possible mechanisms include altered bile acid secretion, altered cellular immunity, hyperinsulinaemia, shared genetic susceptibility and increased bowel length. However, most explanations only offer indirect evidence, and the expectation of acromegaly as a natural model of colorectal carcinogenesis has not materialised. From a clinical perspective, it seems reasonable to consider a once-only colonoscopic screening at approximately age 55 years, but potential risks and benefits should be balanced.
Affiliation:
Department of Surgery, Christie Hospital NHS Trust, Manchester, UK. arenehan@picr.man.ac.uk
Citation:
Acromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications., 35 (11-12):712-25 Horm. Metab. Res.
Journal:
Hormone and Metabolic Research
Issue Date:
27-Aug-2009
URI:
http://hdl.handle.net/10541/78935
DOI:
10.1055/s-2004-814150
PubMed ID:
14710350
Type:
Article
Language:
en
ISSN:
0018-5043
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorRenehan, Andrew G-
dc.contributor.authorO'Connell, J-
dc.contributor.authorO'Halloran, Domhnall J-
dc.contributor.authorShanahan, F-
dc.contributor.authorPotten, Christopher S-
dc.contributor.authorO'Dwyer, Sarah T-
dc.contributor.authorShalet, Stephen M-
dc.date.accessioned2009-08-27T14:35:31Z-
dc.date.available2009-08-27T14:35:31Z-
dc.date.issued2009-08-27T14:35:31Z-
dc.identifier.citationAcromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications., 35 (11-12):712-25 Horm. Metab. Res.en
dc.identifier.issn0018-5043-
dc.identifier.pmid14710350-
dc.identifier.doi10.1055/s-2004-814150-
dc.identifier.urihttp://hdl.handle.net/10541/78935-
dc.description.abstractAcromegaly is an endocrine disorder characterised by sustained hypersecretion of growth hormone (GH) with concomitant elevation of insulin-like growth factor (IGF)-I, and is associated with malignancy and premature mortality from cardiovascular and respiratory diseases. In particular, there may be an increased risk of colorectal neoplasia, but the exact extent of this is contentious. Colonoscopy-based studies of adenoma prevalence rates in acromegalic patients are misleading, but population-based studies on colorectal cancer risk are more consistent - a meta-analysis estimated a pooled risk ratio of 2.04 (95 % CI: 1.32, 3.14). Possible mechanisms underlying this increased risk include direct actions as a consequence of elevated levels of circulating GH and IGF-I and/or other perturbations within the IGF system. Other possible mechanisms include altered bile acid secretion, altered cellular immunity, hyperinsulinaemia, shared genetic susceptibility and increased bowel length. However, most explanations only offer indirect evidence, and the expectation of acromegaly as a natural model of colorectal carcinogenesis has not materialised. From a clinical perspective, it seems reasonable to consider a once-only colonoscopic screening at approximately age 55 years, but potential risks and benefits should be balanced.en
dc.language.isoenen
dc.subjectColonicen
dc.subjectColorectalen
dc.subjectRectalen
dc.subject.meshAcromegaly-
dc.subject.meshAdenoma-
dc.subject.meshAnimals-
dc.subject.meshColonic Neoplasms-
dc.subject.meshColonoscopy-
dc.subject.meshColorectal Neoplasms-
dc.subject.meshHumans-
dc.subject.meshHyperplasia-
dc.subject.meshIncidence-
dc.subject.meshModels, Biological-
dc.subject.meshRectal Neoplasms-
dc.titleAcromegaly and colorectal cancer: a comprehensive review of epidemiology, biological mechanisms, and clinical implications.en
dc.typeArticleen
dc.contributor.departmentDepartment of Surgery, Christie Hospital NHS Trust, Manchester, UK. arenehan@picr.man.ac.uken
dc.identifier.journalHormone and Metabolic Researchen

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