A 28-year-old woman has a 6 cm pituitary tumour causing bitemporal hemianopia. Biochemistry shows GH 45 ng/mL (elevated), IGF-1 3× upper limit. She has coarsened facial features, enlarged hands, and a 'fish mouth' appearance. The cardiovascular complication most closely correlated with mortality in acromegaly is:

• A Hypertensive encephalopathy from sodium retention
• B Aortic regurgitation due to GH-mediated aortic root dilatation
• C Atrial fibrillation due to LA enlargement from elevated GH
• D Acromegalic cardiomyopathy — concentric LV hypertrophy progressing to dilated cardiomyopathy with biventricular failure ✓

Explanation

Acromegalic cardiomyopathy is the leading cardiovascular cause of mortality in acromegaly. Chronic GH and IGF-1 excess cause direct hypertrophic effects on cardiac myocytes — initially concentric LV hypertrophy with preserved systolic function, but progressing to eccentric dilatation, diastolic then systolic dysfunction, and heart failure. GH also promotes sodium/water retention and hypertension, worsening cardiac load. Successful control of GH (surgery or somatostatin analogues) partially reverses cardiac hypertrophy.

Reference: Guyton & Hall, Textbook of Medical Physiology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.