CLINICAL PERSPECTIVE Acromegaly and Cancer: Not a Problem?

Acromegaly is usually caused by a GH-secreting pituitary adenoma. Somatic growth and metabolic dysfunction occur subsequent to unrestrained GH secretion and elevated insulin-like growth factor (IGF)-I and IGF-binding protein (IGFBP)-3 levels (1) (Fig 1 ). Classic clinical features of acromegaly include acral overgrowth, sweating, headaches, menstrual disturbances, and glucose intolerance (Table 1 ) (2). Well-documented clinical risks of long-term tissue exposure to uncontrolled GH hypersecretion include cardiac disease and hypertension, diabetes, respiratory disorders, joint disease, and neuropathy (Table 2 ) (3). The degree of risk for malignancy in these patients is unresolved; and acromegaly, representing an experiment of nature, could answer the question of whether or not elevated GH and IGF levels provide a permissive growth advantage for neoplasms, resulting in more aggressive malignant disease and/or increased cancer-associated mortality (4).