Acromegalic Cardiomyopathy

Acromegalic cardiomyopathy is specific myocardial disease from chronic GH and IGF 1 excess.

• Present in 50 to 70% of acromegaly patients, related to duration and disease activity.
• Stages: hyperkinetic (early), hypertrophic with diastolic dysfunction, then dilated with systolic failure.
• Contributors: hypertension, diabetes, sleep apnoea, valve disease, arrhythmia, coronary disease.
• Cardiovascular disease is a leading cause of death in acromegaly.

• Dyspnoea, exercise intolerance, palpitations, oedema.
• Concentric biventricular hypertrophy, arrhythmias (ectopy, AF), conduction disease, valvular regurgitation.
• Typical acromegalic features: coarse facies, large hands/feet, sweating.

• IGF 1 and GH (oral glucose suppression: GH nadir above 1 micrograms/L), pituitary MRI.
• ECG, echocardiography (left ventricular mass, diastolic function, valves), 24 hour Holter, blood pressure monitoring, polysomnography.
• Cardiac MRI for fibrosis; coronary assessment as indicated.
• Screen for diabetes, lipids.

• Control GH/IGF 1: transsphenoidal surgery, octreotide LAR 20 to 30 mg monthly or lanreotide 120 mg monthly, pasireotide LAR 40 to 60 mg monthly, cabergoline 0.5 to 3.5 mg weekly, pegvisomant 10 to 30 mg daily; radiotherapy as adjunct. Biochemical control often reverses hypertrophy and improves function.
• Cardiac therapy as for heart failure: ACE inhibitor/ARB, beta blocker, diuretics, MRA, SGLT2 inhibitor.
• Treat hypertension (target below 130/80), diabetes, sleep apnoea (CPAP), lipids.
• Rhythm management and anticoagulation for AF.
• Echo surveillance every 1 to 2 years.