Evaluation of Hematological Indices in Acromegalic Patients

Yıl 2023, Cilt: 18 Sayı: 2, 87 - 92, 12.07.2023

Emek Topuz , Dilek Tüzün , Ümit Nur Özbay , Murat Şahin

https://doi.org/10.17517/ksutfd.1179747

Öz

Objective: Acromegaly is a chronic systemic disease characterized by autonomous and excessive secretion of growth hormone (GH). Acromegaly is most
commonly caused by ais a somatotroph adenoma of the anterior pituitary. In acromegaly, mortality primarily results from are cerebrovascular, cardiovascular,
respiratory diseases and malignancies. Monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW),
platelet distribution width (PDW) and delta neutrophil index (DNI) are popular inflammatory markers. This study’s purpose was to assess pre/post-treatment
levels of NLR, GH, RDW, MLR, PDW and DNI in acromegalic patients and to investigate the impact of acromegaly treatment on these markers.
Materials and Methods: Twenty-six patients with acromegaly, treated and followed at our endocrinology outpatient clinic between April 2014 and February
2022 were included in the study. Age, sex, comorbidities, medications, complete blood count, kidney and liver function tests, pathology reports, tumor
size, pre/post-treatment levels of IGF-1, GH, DNI, NLR, MLR, RDW and PDW were retrieved from patients’ files and outcomes were evaluated.
Results: Among 26 patients included in the study, 12 (46%) were female and 14 (53%) were male. The average age of the patients was 53.73±16.21 years
(range, 25-79). There were 11 (42%) patients with type 2 diabetes mellitus and 9 (34%) patients with hypertension. A statistically significant reduction was
observed in post-operative GH, IGF-1, NLR, DNI, PDW and RDW values compared to preoperative values (during active disease phase) and at 6 months in
patients with postoperative cure, and compared to pretreatment values in patients without postoperative remission who received medical treatment. A reduction
was also observed in post-treatment MLR compared to pretreatment ratio but the difference was non-significant. There was no statistically significant
correlation between the IGF-1 levels at the time of diagnosis and NLR, RDW, PDW in patients with acromegaly.
Conclusion: Studies on the values of circulating inflammatory biomarkers in patients with acromegaly and their relationship to treatment remain unclear. In
our study, higher pre-treatment GH, IGF-1, NLR, DNI, PDW, RDW values were found compared to post- treatment. This suggests that having chronically
higher than normal values of IGF-1 may also lead to increased inflammatory markers such as NLR and increased atherosclerotic risk. Chronic subclinical
inflammation caused by uncontrolled disease might lead to an increase in mortality and morbidity in acromegalic patients. Therefore, early diagnosis and
treatment of acromegaly are crucial.

Anahtar Kelimeler

Acromegaly, delta neutrophil index., monocyte/lymphocyte ratio, neutrophil/lymphocyte ratio

Proje Numarası

Yok

Akromegali Hastalarında Hematolojik İndekslerin Değerlendirilmesi

Öz

Amaç: Akromegali, genellikle hipofiz adenomu tarafından salgılanan otonom büyüme hormonu (BH) fazlalığı ile giden bir hastalıktır. Akromegalide mortalitenin
ana nedeni serebrovasküler, kardiyovasküler, solunum olayları ve malignitelerdir. Nötrofil/lenfosit oranı (NLR), monosit/lenfosit oranı (MLR), eritrosit
dağılım genişliği (RDW) ve trombosit dağılım genişliği (PDW), Delta nötrofil indeks (DNİ) popüler inflamasyon markerlarıdır. Bu çalışmada akromegali hastalarında
tedavi öncesi ve sonrasında IGF-1, BH, DNİ, NLR, MLR, RDW ve PDW parametrelerini inceleyerek değerlendirmeyi ve akromegali tedavisinin bu
parametreler üzerindeki etkisini araştırmayı amaçladık.
Gereç ve Yöntemler: Hastanemiz Endokrinoloji polikliniğinde Nisan 2014 -Şubat 2022 yıllarında takip ve tedavi edilen akromegali hastalarının dosyalarından
ve hastane kayıtlarından yaş, cinsiyet, ek hastalıkları, kullandığı ilaçlar, tam kan sayımı, böbrek fonksiyon testleri, karaciğer fonksiyon testleri, patoloji sonuçları,
tümör boyutları, ek komorbiditelerini kaydederek sonuçlarını değerlendirdik. Tedavi öncesi ve sonrasında rutin olarak elde edilmiş olan IGF-1, BH, DNİ, NLR,
MLR, RDW ve PDW düzeylerini inceleyerek karşılaştırdık.
Bulgular: Çalışmaya alınan toplam 26 hastanın, 12 si kadın (%46), 14 ü erkek (%53) idi. Hastaların yaşları 25 ile 79 (ortalama: 53.73±16.21 ) arasındaydı.
Hastaların 11 tanesinin (%42) tip 2 diyabetes mellitus, 9 tanesinin (%34) hipertansiyon tanısı mevcuttu. Hastaların cerrahi öncesi aktif hastalık döneminde ve
cerrahi sonrası kür olan hastaların 6. aydaki değerleri ile cerrahi sonrası remisyona girmeyen medikal tedavi alan hastaların, tedavi sonrası BH, IGF-1, NLR,
DNI, PDW, RDW değerlerinde tedavi öncesi değerlere göre istatistiksel olarak anlamlı düşüş izlendi. M/L oranında da tedavi sonrası değerler tedavi öncesi
değerlere göre düşmüştü fakat istatiksel olarak anlamlı değildi. Akromegali hastalarında tanı anındaki IGF-1 düzeyi ile NLR, RDW, PDW arasında istatiksel
olarak anlamlı bir ilişki saptanmadı.
Sonuç: Akromegalide kardiyovasküler hastalık sıklığı ve kardiyovasküler risk faktörleri artmıştır. Akromegali hastalarında dolaşımdaki inflamatuar belirteçlerin
düzeyleri ve bunların tedaviyle ilişkisi üzerine yapılan çalışmalar çelişkilidir. Bizim çalışmamızda GH, IGF-1, NLR, DNI, PDW, RDW değerlerinde tedavi
öncesinde tedavi sonrasına göre yüksek değer saptanmıştır. Yüksek seviyelerde IGF-1’e uzun süreli maruz kalmanın, NLR gibi inflamutuar belirteçlerde artış
ve aterosklerotik riskte artma ve buna bağlı olarak artmış kardiyovasküler riske de yol açabileceğini düşündürmektedir. Kontrolsüz hastalığa bağlı subklinik inflamasyondaki
artışlar, akromegali hastalarında artan morbidite ve mortaliteye katkıda bulunabilir. Bu nedenle akromegalide erken tanı ve tedavi çok önemlidir.

Anahtar Kelimeler

Akromegali, ,delta nötrofil indeks, ,monosit/lenfosit oranı, nötrofil/lenfosit oranı

Destekleyen Kurum

Yok

Proje Numarası

Yok

Kaynakça

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