Prevalence of colonic polyps among patients with Acromegaly

• Published in: Sri Lanka journal of diabetes endocrinology and metabolism Vol. 8; no. 2; pp. 19 - 25
• Main Authors: Pathmanathan, S., Somasundaram, Noel P., Nawarathne, N. M. M.
• Format: Journal Article
• Language: English
• Published: Sri Lanka College of Endocrinologists 29-08-2018
• Subjects: acromegaly, colonic polyps, screening colonoscopy, sri lanka
• ISSN: 2012-998X; 2012-998X
• DOI: 10.4038/sjdem.v8i2.7362

Background: Patients with acromegaly are reported to have a higher prevalence of colorectal adenoma, which is a pre-malignant condition. It has been recommended that patients with acromegaly should undergo colonoscopic surveillance to detect these lesions early.

Aims and Objectives: Our objective was to evaluate the prevalence of colonic polyps in patients with acromegaly.

Materials: This was a descriptive cross-sectional study conducted in the Endocrinology and Pituitary clinics at National Hospital of Sri Lanka between January 2012 and June 2013. From a total of 72 patients with acromegaly, 33 patients (13 males and 20 females), who underwent colonoscopy were enrolled for analysis. Age group of this sample was 29 to 71 years. None of these patients had previous or family history of colonic neoplasm or colonic surgery.

Results: The mean age of the patients at diagnosis was 40.12 (SD±11.9) years and average lag time between symptomatology and diagnosis of acromegaly in these patients were 3.5 (SD ± 2.8) years. The basal mean plasma Growth hormone was 57.91 mU/L (SD±53.74) and on imaging 28 (84.84%) had tumour of grade II or above. Colonoscopic examination was complete up to the cecum in 23 patients (69.69%), to the splenic flexure in eight patients (24.24%) and to hepatic flexure in the remaining two patients (6.06%). Five patients (15%) with acromegaly had polyps in their colonoscopy in which two of them had tubular adenoma with low grade dysplasia. The group of acromegalic patients with and without polyps did not differ significantly in age 39.8±13.3 years vs 39.71 ±11.34 years, (p= 0.326), in duration of disease 2.8 ±2.0 years vs 3.6±3.0 years, (p=0.544) or in circulating basal GH levels (77.13 ±64.91mU/L vs 42.61±42.70 mU/L, p= 0.134). Diabetes did not influence the prevalence of colonic polyps in acromegaly (Chi-Squared test; p=0.478). Having polyps was statistically significantly higher among male sex than female sex (p<0.05), but a conclusion cannot be made due to small sample size. Four out of the 5 acromegalic patients who had polyps had active disease when the colonoscopy was performed.

Conclusion: Despite lower prevalence of colonic polyps (15%) compared to studies from the west, we still found premalignant lesions in 2 patients (6.06%). Therefore, we suggest that acromegalic patients should undergo screening colonoscopy.