Prevalência de câncer em pacientes acromegálicos atendidos no Centro de Especialidades Médicas do CESUPA

Abstract

Introduction: Acromegaly is a rare, debilitating, slow-progressing and chronic endocrinopathy, resulting from pathological growth hormone (GH) hypersecretion and subsequent levels of insulin-like growth factor-1 (IGF-1). a moderate risk of cancer in acromegalic patients with uncontrolled disease and a greater association of acromegaly with colorectal, thyroid and, to a lesser extent, breast, kidney, prostate, bone cancer. As a result, an important current debate questions whether patients with acromegaly should undergo specific cancer screening and surveillance protocols. Objectives: To identify the prevalence of cancer in acromegalic patients treated at the Cesupa Medical Specialties Center. Methodology: This is an epidemiological, crosssectional and retrospective study, based on exploratory analysis of the medical records of the Endocrinology Service of the Cesupa Medical Specialties Center (CEMEC) - Belém/PA from October 2019 to October 2020.Results: The prevalence of cancer among acromegalic patients treated at CEMEC is 18.18%, 8 cases out of 44 patients.The proportion of men and women affected is the same (50%). It was evidenced that the patients have an average age equal to 68 years, with a variation of ± 13 years (σ = 12.79), with a minimum age of 46 years and a maximum age of 88 years. Patients had 6 different types of Ca, the most prevalent is Colon Cancer seen in 3 patients (38%), followed by 1 case of the other types of cancer: breast, prostate, lymphoma, thyroid and gastric. It was seen that the main comorbidity is high blood pressure (5; 75%), 1 (13%) patient has metastasized, 1 (13%) patient has a family history of Ca and 3 (38%) patients have a smoking history. Moreover, of the 4 patients (50%) who died, 3 were due to cancer. In the first evaluation, patients presented mean GH equal to 6.2, increasing to 8.7 in the final evaluation. Considering the number of patients who presented compensated IGN-1 LSN levels at the beginning and at the end of the segment performed at CEMEC, a 25% increase in the number of patients who started to have controlled serum levels of this hormone was observed. At Cemec, a proprietary screening protocol that includes colonoscopy and ultrasound of the thyroid for all patients diagnosed with Acromegaly.Conclusion: According to the clinical and epidemiological profile of these patients, most were decompensated at the beginning of the follow-up at the service, and after they started multimodal therapies including surgery, medications and radiotherapy when necessary.In the last record, most patients were compensated, showing the conduction of appropriate treatment within the clinic.It is agreed that the screening tests adopted at this service , one of the bare of paramount importance in the group, considering that colon and thyroid cancer are the most prevalent in acromegalic patients today, as well as having a greater scientific basis to justify such screening.This work is of great value for a more global clinical analysis of a complication of high morbidity and mortality among acromegalics, the cancer, inside one of the main reference centers of treatment for acromegaly in the North-Northeast Brazil.