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

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    Authors
    Renehan, Andrew G
    O'Connell, J
    O'Halloran, Domhnall J
    Shanahan, F
    Potten, Christopher S
    O'Dwyer, Sarah T
    Shalet, Stephen M
    Affiliation
    Department of Surgery, Christie Hospital NHS Trust, Manchester, UK. arenehan@picr.man.ac.uk
    Issue Date
    2009-08-27T14:35:31Z
    
    Metadata
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    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.
    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
    URI
    http://hdl.handle.net/10541/78935
    DOI
    10.1055/s-2004-814150
    PubMed ID
    14710350
    Type
    Article
    Language
    en
    ISSN
    0018-5043
    ae974a485f413a2113503eed53cd6c53
    10.1055/s-2004-814150
    Scopus Count
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    All Christie Publications

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