Exploring Brain Parenchymal Changes in Acromegaly: Focus on White Matter Hyperintensities

Introduction: Acromegaly is a rare chronic disease caused by excessive secretion of growth hormone. Even with biochemical control, hormonal imbalance may lead to cerebral changes. This study aimed to evaluate the presence of white matter hyperintensities (WMHs) in patients with acromegaly. Materials and Methods: We retrospectively enrolled 37 acromegaly patients who underwent gadolinium-enhanced brain MRI to detect WMHs and their distribution. We analysed potential contributing factors such as cardiovascular comorbidities, migraine, inflammatory markers (plasma interleukin-33), and hand skin perfusion using laser speckle contrast analysis. Results: WMHs were found in 24 patients (64.9%), with nine showing a higher lesion burden. Patients with WMHs were older [63 years (IQR 47.5–67.5) versus 48 years (IQR 44–53), p = 0.023] and had a longer disease duration [19 years (IQR 11.5–26.5) versus 13 years (IQR 12–15), p = 0.028] than those without WMHs. Hypertension (22/37) and migraine (18/37) were the most common comorbidities. A higher WMH burden was significantly associated with hypertension (p = 0.05), while no significant link was found between WMHs and migraine (p > 0.05). Conclusion: Several factors in acromegaly may affect brain structure, promoting WMH development, such as aging, disease duration, and hypertension. Therefore, in patients with acromegaly, we suggested the early management of cardiovascular comorbidities and regular radiological follow-up, not limited to the study of the pituitary gland. Future prospective studies are necessary to confirm our preliminary observations and to clarify the potential role of disease activity and treatment in WMH development.