MARKED IMPROVEMENT OF CARDIOVASCULAR FUNCTION AFTER SUCCESSFUL TRANSSPHENOIDAL SURGERY IN ACROMEGALIC PATIENTS

Objective Transsphenoidal surgery results in biochemical remission of acromegaly in 45-80% of patients; however, few studies have addressed the impact of transsphenoidal surgery on cardiovascular function in acromegalic patients. The aim of this prospective study was to investigate the effects of postoperative GH/IGF-I normalization on echocardiographic parameters and blood pressure (BP) in a series of patients with active acromegaly. Design An open prospective study. Patients Thirty newly diagnosed acromegalic patients undergoing transsphenoidal surgery. Measurements Doppler echocardiography and 24-h ambulatory blood pressure monitoring were performed before and 6 months after transsphenoidal surgery. Results Fifteen patients were considered to be well controlled postoperatively (group A), as defined by normal age-corrected IGF-I levels and glucose-suppressed GH levels less than 2 mU/I, the remaining 15 patients being considered as poorly controlled (group B). In group A, a postoperative decrease of left ventricular mass index was observed (104.4 +/-6.6 vs. 127.1 +/-7.7 g/m(2); P<0.001), associated with an improvement of some indices of diastolic function, such as an increase of the early/late transmitral peak flow velocity (P<0.05) and a decrease of isovolumic relaxation time (P<0.01). No significant change was observed in group B. A significant decrease of 24-h systolic BP was also observed in group A (P<0.05) and five of six patients normalized their BP circadian rythm. In contrast, a nonsignificant increase in BP values, with a persistent blunted BP profile where present, was observed in group B. Conclusions We conclude that successful transsphenoidal surgery is able to induce a significant improvement in some cardiac parameters and a slight reduction in systolic blood pressure in acromegalic patients.