Investig Magn Reson Imaging.  2019 Dec;23(4):395-400. 10.13104/imri.2019.23.4.395.

Dilated Cardiomyopathy in Acromegaly: a Case Report with Cardiac MR Findings

Affiliations
  • 1Department of Radiology, Inha University Hospital, Incheon, Korea.
  • 2Department of Radiology, Seoul National University Hospital, Seoul, Korea. hyewon101@hotmail.com

Abstract

Acromegaly is a rare endocrine disorder caused by excessive secretion of the growth hormone. There is a wide range of clinical manifestations from somatic symptoms to respiratory or cardiac failure. Among them, cardiovascular involvement is a leading cause of morbidity and mortality. There are relatively few cases reporting cardiac magnetic resonance imaging (CMR) findings of cardiomyopathy in patients with acromegaly. Thus, we report a case of acromegaly showing dilated cardiomyopathy focusing on the findings of CMR.

Keyword

Acromegaly; Magnetic resonance imaging; Cardiomyopathy

MeSH Terms

Acromegaly*
Cardiomyopathies
Cardiomyopathy, Dilated*
Growth Hormone
Heart Failure
Humans
Magnetic Resonance Imaging
Mortality
Growth Hormone

Figure

  • Fig. 1 Magnetic resonance images of the pituitary macroadenoma. Sagittal T1-weighted image (a) and axial T2-weighted image (b) shows intermediate to low signal intensity of the mass (arrows). Coronal (c) and sagittal (d) contrast-enhanced T1-weighted images of the brain reveal a strong, heterogeneously enhancing solid sellar mass (arrows). The normal pituitary gland is not discernible.

  • Fig. 2 (a, b) Transthoracic echocardiogram images of the patient. An apical 4-chamber view shows dilated left ventricle with decreased calculated ejection fraction (49%) and global hypokinesia with trivial mitral regurgitation and trivial tricuspid regurgitation.

  • Fig. 3 Cine images during end-diastolic (a) and end-systolic (b) phases demonstrate dilated left ventricle (LV) with mild global hypokinesia with ejection fraction of 44.8%. Late gadolinium enhancement (LGE) images with magnitude and phase-sensitive inversion recovery (c) show patchy delayed enhancement (arrow) in mid inferoseptal wall of LV. The enhancement pattern is distinct from that associated with coronary artery disease because of subendocardial sparing and non-coronary territory distribution. Native T1 map value (d) slightly increased at the LV septal wall both LGE positive and LGE negative myocardium (1280 and 1250 msec, respectively). Extracellular volume fraction of LV myocardium (e), measured at LGE negative myocardium, was 28.0%.


Reference

1. Lavrentaki A, Paluzzi A, Wass JA, Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary. 2017; 20:4–9.
2. Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. Int J Endocrinol. 2012; 2012:540398.
3. Bihan H, Espinosa C, Valdes-Socin H, et al. Long-term outcome of patients with acromegaly and congestive heart failure. J Clin Endocrinol Metab. 2004; 89:5308–5313.
4. dos Santos Silva CM, Gottlieb I, Volschan I, et al. Low frequency of cardiomyopathy using cardiac magnetic resonance imaging in an acromegaly contemporary cohort. J Clin Endocrinol Metab. 2015; 100:4447–4455.
5. Sharma AN, Tan M, Amsterdam EA, Singh GD. Acromegalic cardiomyopathy: epidemiology, diagnosis, and management. Clin Cardiol. 2018; 41:419–425.
6. Dabir D, Child N, Kalra A, et al. Reference values for healthy human myocardium using a T1 mapping methodology: results from the International T1 multicenter cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2014; 16:69.
7. Haaf P, Garg P, Messroghli DR, Broadbent DA, Greenwood JP, Plein S. Cardiac T1 mapping and extracellular volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson. 2016; 18:89.
8. Dargad RR, Parekh JD, Dargad RR. Acromegaly with dilated cardiomyopathy. J Assoc Physicians India. 2016; 64:96–97.
9. Giesbrandt KJ, Bolan CW, Shapiro BP, Edwards WD, Mergo PJ. Diffuse diseases of the myocardium: MRI-pathologic review of nondilated cardiomyopathies. AJR Am J Roentgenol. 2013; 200:W266–W273.
Full Text Links
  • IMRI
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr