Quantificação e correlação do volume pulmonar de pacientes com acromegalia por meio de tomografia computadorizada e testes de função pulmonar

Abstract

Acromegaly is a multisystemic disease caused by hypersecretion of growth hormone (GH) and growth factor insulin-like type I (IGF-I). Acromegaly is associated with a significant increase in morbidity and mortality and respiratory impairment is considered as the second cause of death. It is estimated that respiratory problems still contribute 25% of all deaths found in this group of patients. Methodological differences between the studies led to the emergence of inconsistent data on the role of alveolar growth in the development of increased lung volume in acromegaly, which reinforces the importance of new jobs and other approaches to the topic. At the same time, technological development, imaging methods proposed in some studies have been replaced by more sensitive such as computed tomography (CT) multislice (Q-MDCT) that ensures proper measurement of lung volume, which provides different types of comparison and analysis, and also allows the anatomical study of the thorax and pulmonary routes. Our objectives were to identify the main findings of computed tomography (CT) in acromegaly patients, determine by means of chest CT lung volume and compare the findings of lung densitometry with pulmonary function in acromegalic patients with active disease and control the disease and, secondly, to correlate these findings. A cross-sectional study of 29 patients with acromegaly who have had diagnosis of acromegaly suspected by clinical features and confirmed by high levels of GH not suppressed or IGF-I levels above the normal limit was conducted. Subsequently, patients were divided into the groups 'active disease' (11 individuals) and 'controlled disease' (18 subjects), according to the serum levels of IGF-I. There was also a control group (17 subjects) in which patients, after having already performed chest CT for some reason, were invited to perform pulmonary function tests. The Q-MDCT and pulmonary function tests showed excellent correlation: the total lung volume (TLV) measured in inspiratory CT showed a significant correlation with the total lung capacity (rs = 0.742, p = 0.0001), as measured in the expiratory CT showed a significant correlation with functional residual capacity (rs = 0.606, p = 0.0005). Acromegalic patients with active disease had heavier lungs compared to controls [885 (723-994) vs. 696 (599-769) g, p = 0.017]. Patients with active acromegaly also had higher amounts of poorly aerated compartments compared with the other two groups, and this difference was observed in TLV% [3.25 (2.55 to 3.46) vs. 2.24 (1.70 to 2.56) vs. 1.70 (1.45 to 2.15), p = 0.001] and g [82.6 (75.4 -100.2) versus 63.9 (49.1 to 80.3) vs. 54.2 (42.2 to 59.2), p = 0.0001]. The poorly aerated compartment measured in inspiratory CT showed a significant correlation with GH and IGF levels (rs = 0.407, p = 0.029; rs = 0.467, p = 0.011, respectively). In conclusion, Q-MDCT shows that acromegalic patients with active disease have heavier and larger amounts of lung compartments poorly aerated and not aerated. There are relations between the findings of lung densitometry and the parameters of pulmonary function tests in patients with acromegaly.