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Zabkowski T. et al., 2023: Analysis of Nephrolithiasis Treatment in Highest Reference Hospital-Occurrence of Acromegaly in the Study Group

Ząbkowski T, Durma AD, Grabińska A, Michalczyk Ł, Saracyn M.
Department of Urology, Military Institute of Medicine-National Research Institute, 02-637 Warsaw, Poland.
Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine-National Research Institute, 02-637 Warsaw, Poland.
Urology Department, District Hospital, 26-900 Kozienice, Poland.

Abstract

Background: Urolithiasis is one of the most common diseases of the urinary system, the incidence of which is assumed to be up to 100,000 cases per million (10% of the population). The cause of it is dysregulation of renal urine excretion. Acromegaly is a very rare endocrine disorder that causes a somatotropic pituitary adenoma producing higher amounts of growth hormone. It occurs approximately in 80 cases per million (about 0.008% of the population). One of the acromegaly complications may be urolithiasis.

Methods: Clinical and laboratory results of 2289 patients hospitalized for nephrolithiasis in the highest reference hospital were retrospectively analyzed, distinguishing a subgroup of patients with acromegaly. Statistical analysis was performed to compare the prevalence of the disease in the analyzed subgroup with the epidemiological results available in up-to-date literature.

Results: The distribution of nephrolithiasis treatment was definitely in favor of non-invasive and minimally invasive treatment. The methods used were as follows: ESWL (61.82%), USRL (30.62%), RIRS (4.15%), PCNL (3.1%), and pyelolithotomy (0.31%). Such a distribution limited the potential complications of the procedures while maintaining the high effectiveness of the treatment. Among two thousand two hundred and eighty-nine patients with urolithiasis, two were diagnosed with acromegaly before the nephrological and urological treatment, and seven were diagnosed de novo. Patients with acromegaly required a higher percentage of open surgeries (including nephrectomy) and also had a higher rate of kidney stones recurrence. The concentration of IGF-1 in patients with newly diagnosed acromegaly was similar to those treated with somatostatin analogs (SSA) due to incomplete transsphenoidal pituitary surgery.

Conclusions: In the population of patients with urolithiasis requiring hospitalization and interventional treatment compared to the general population, the prevalence of acromegaly was almost 50-fold higher (p = 0.025). Acromegaly itself increases the risk of urolithiasis.

J Clin Med. 2023 Jun 6;12(12):3879.
doi: 10.3390/jcm12123879. PMID: 37373574 FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Monday, 19 February 2024 11:00

This report deals with the risk of urolithiasis associated with acromegaly. Acromegaly as a cause of stone formation is not commonly observed in the population, but the authors of this article found that the incidence of acromegaly in their group of patients was 0.39% which is 50 times the prevalence of acromegaly in the general population: 0.008%!

The mechanism of the increased risk of stone formation is as follows:
Pituitary adenoma
Somatotropin increase

Excessive production of Growth Hormone and IGF1 (insulin-like growth factor)

1,25 (OH)2 D-vitamin increase
Hypercalcemia

It is of note that this disease was more common among women (60%).
In the group of 2289 patients evaluated in this Polish reference hospital, the methods for stone removal were as follows:
https://www.storzmedical.com/images/blog/Zabkowski.PNG

It is important to be aware of this rare relationship between acromegaly and stone disease and offer these patients appropriate endocrine surgery or, if that is not possible, treatment with somatostatin analogues.

Hans-Göran Tiselius

This report deals with the risk of urolithiasis associated with acromegaly. Acromegaly as a cause of stone formation is not commonly observed in the population, but the authors of this article found that the incidence of acromegaly in their group of patients was 0.39% which is 50 times the prevalence of acromegaly in the general population: 0.008%! The mechanism of the increased risk of stone formation is as follows: Pituitary adenoma Somatotropin increase Excessive production of Growth Hormone and IGF1 (insulin-like growth factor) 1,25 (OH)2 D-vitamin increase Hypercalcemia It is of note that this disease was more common among women (60%). In the group of 2289 patients evaluated in this Polish reference hospital, the methods for stone removal were as follows: [img]https://www.storzmedical.com/images/blog/Zabkowski.PNG[/img] It is important to be aware of this rare relationship between acromegaly and stone disease and offer these patients appropriate endocrine surgery or, if that is not possible, treatment with somatostatin analogues. Hans-Göran Tiselius
Monday, 20 May 2024