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Erschienen in: Endocrine 2/2018

08.03.2018 | Original Article

Oro-dental pathologies in acromegaly

verfasst von: Ilonka Kreitschmann-Andermahr, Johannes Kohlmann, Bernadette Kleist, Ursula Hirschfelder, Rolf Buslei, Michael Buchfelder, Sonja Siegel

Erschienen in: Endocrine | Ausgabe 2/2018

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Abstract

Purpose

Oro-dental pathologies (ODP) such as enlargement of the tongue, mandibular prognathism, and spaced teeth are characteristic features of acromegaly. Their frequency of occurrence during the course of the disease is largely unresolved. Purpose of this study was to assess ODP and oro-dental treatments in patients with acromegaly with regard to the length of the diagnostic process, tumor histology, and quality of life (QoL).

Methods

Single-center retrospective survey study using questionnaires on dental symptoms, diagnostic process, and treatment in patients with acromegaly operated on a growth hormone-secreting pituitary adenoma. The association between ODP and QoL was assessed using the Short-Form 36 (SF-36) Health Survey.

Results

145/314 patients completed the questionnaires. 80.7% were affected by any ODP, most frequently enlargement of the tongue (57.9%), spaced teeth (42.8%), mandibular growth (24.1%), and mandibular prognathism (22.1%). ODP were significantly more frequent in patients with sparsely vs. densely granulated adenomas (p = 0.045). Early diagnosis within 2 years was associated with significantly fewer ODP than later diagnosis (68.5 vs. 87.2%, p = 0.009). Treatments included dental crowns (16.6%), dental bridges (12.4%), dental implants (9.7%), dental prostheses (3.4%), orthodontal (i.e., braces, 6.9%), and surgical correction of the teeth (2.1%). Physical QoL was significantly lower in patients with ODP than in those without (p = 0.014).

Conclusion

In our large series of patients, four of five patients were affected by ODP at any time during the course of the disease. The results highlight the importance of early identification and treatment of oro-dental problems in patients with acromegaly as hallmarks of the disease.
Literatur
2.
3.
Zurück zum Zitat D.T. Adelman, K.J. Liebert, L.B. Nachtigall, M. Lamerson, B. Bakker, Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment. Int. J. Gen. Med. 6, 31–38 (2013)CrossRefPubMedPubMedCentral D.T. Adelman, K.J. Liebert, L.B. Nachtigall, M. Lamerson, B. Bakker, Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment. Int. J. Gen. Med. 6, 31–38 (2013)CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat M.R. Drange, N.R. Fram, V. Herman-Bonert, S. Melmed, Pituitary tumor registry: a novel clinical resource. J. Clin. Endocrinol. Metab. 85(1), 168–174 (2000)PubMed M.R. Drange, N.R. Fram, V. Herman-Bonert, S. Melmed, Pituitary tumor registry: a novel clinical resource. J. Clin. Endocrinol. Metab. 85(1), 168–174 (2000)PubMed
5.
Zurück zum Zitat C. Rajasoorya, I.M. Holdaway, P. Wrightson, D.J. Scott, A.K. Ibbertson, Determinants of clinical outcome and survival in acromegaly. Clin. Endocrinol. 58, 95–102 (1994)CrossRef C. Rajasoorya, I.M. Holdaway, P. Wrightson, D.J. Scott, A.K. Ibbertson, Determinants of clinical outcome and survival in acromegaly. Clin. Endocrinol. 58, 95–102 (1994)CrossRef
6.
Zurück zum Zitat L. Nachtigall, A. Delgado, B. Swearingen, H. Lee, R. Zerikly, A. Klibanski, Changing patterns in diagnosis and therapy of acromegaly over two decades. J. Clin. Endocrinol. Metab. 93(6), 2035–2041 (2008)CrossRefPubMed L. Nachtigall, A. Delgado, B. Swearingen, H. Lee, R. Zerikly, A. Klibanski, Changing patterns in diagnosis and therapy of acromegaly over two decades. J. Clin. Endocrinol. Metab. 93(6), 2035–2041 (2008)CrossRefPubMed
7.
Zurück zum Zitat I. Kreitschmann-Andermahr, S. Siegel, B. Kleist, J. Kohlmann, D. Starz, R. Buslei, M. Koltowska-Haggstrom, C.J. Strasburger, M. Buchfelder, Diagnosis and management of acromegaly: the patient’s perspective. Pituitary 19(3), 268–276 (2016)CrossRefPubMed I. Kreitschmann-Andermahr, S. Siegel, B. Kleist, J. Kohlmann, D. Starz, R. Buslei, M. Koltowska-Haggstrom, C.J. Strasburger, M. Buchfelder, Diagnosis and management of acromegaly: the patient’s perspective. Pituitary 19(3), 268–276 (2016)CrossRefPubMed
8.
Zurück zum Zitat G. Atreja, S.H. Atreja, N. Jain, U. Sukhija, Oral manifestations in growth hormone disorders. Indian J. Endocrinol. Metab. 16(3), 381–383 (2012)CrossRefPubMedPubMedCentral G. Atreja, S.H. Atreja, N. Jain, U. Sukhija, Oral manifestations in growth hormone disorders. Indian J. Endocrinol. Metab. 16(3), 381–383 (2012)CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat K. Tornes, O. Gilhuus-Moe, Correction of jaw deformities subsequent to treatment of acromegaly. Int. J. Oral Maxillofac. Surg. 15(4), 446–450 (1986)CrossRefPubMed K. Tornes, O. Gilhuus-Moe, Correction of jaw deformities subsequent to treatment of acromegaly. Int. J. Oral Maxillofac. Surg. 15(4), 446–450 (1986)CrossRefPubMed
10.
Zurück zum Zitat S. Dostalova, K. Sonka, Z. Smahel, V. Weiss, J. Marek, Cephalometric assessment of cranial abnormalities in patients with acromegaly. J. Craniomaxillofac. Surg. 31(2), 80–87 (2003)CrossRefPubMed S. Dostalova, K. Sonka, Z. Smahel, V. Weiss, J. Marek, Cephalometric assessment of cranial abnormalities in patients with acromegaly. J. Craniomaxillofac. Surg. 31(2), 80–87 (2003)CrossRefPubMed
11.
Zurück zum Zitat M. Takakura, T. Kuroda, Morphologic analysis of dentofacial structure in patients with acromegaly. Int. J. Adult Orthodon. Orthognath. Surg. 13(4), 277–288 (1998)PubMed M. Takakura, T. Kuroda, Morphologic analysis of dentofacial structure in patients with acromegaly. Int. J. Adult Orthodon. Orthognath. Surg. 13(4), 277–288 (1998)PubMed
12.
Zurück zum Zitat D.L. Lima, R.M. Montenegro Jr, A.P. Vieira, M.F. Albano, D.M. Rego, Absence of periodontitis in acromegalic patients. Clin. Oral Investig. 13(2), 165–169 (2009)CrossRefPubMed D.L. Lima, R.M. Montenegro Jr, A.P. Vieira, M.F. Albano, D.M. Rego, Absence of periodontitis in acromegalic patients. Clin. Oral Investig. 13(2), 165–169 (2009)CrossRefPubMed
14.
Zurück zum Zitat R.B. Cohen, C.W. Wilcox, A case of acromegaly identified after patient complaint of apertognathia. Oral Surg. Oral Med. Oral Pathol. 75(5), 583–586 (1993)CrossRefPubMed R.B. Cohen, C.W. Wilcox, A case of acromegaly identified after patient complaint of apertognathia. Oral Surg. Oral Med. Oral Pathol. 75(5), 583–586 (1993)CrossRefPubMed
15.
Zurück zum Zitat T. Sugata, Y. Myoken, S. Tanaka, Acromegaly identified in a patient with a complaint of malocclusion. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 85(1), 44–46 (1998)CrossRefPubMed T. Sugata, Y. Myoken, S. Tanaka, Acromegaly identified in a patient with a complaint of malocclusion. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 85(1), 44–46 (1998)CrossRefPubMed
16.
Zurück zum Zitat B. Sivapathasundharam, R. Rajendran, in Shafer’s Textbook on Oral Pathology, ed. by G.W. Shafer, M.K. Hine, B.M. Levy (Elsevier India, Elsevier, a division of Reed Elsevier India Private Limited, New Delhi, 2012), pp. 616–664 B. Sivapathasundharam, R. Rajendran, in Shafer’s Textbook on Oral Pathology, ed. by G.W. Shafer, M.K. Hine, B.M. Levy (Elsevier India, Elsevier, a division of Reed Elsevier India Private Limited, New Delhi, 2012), pp. 616–664
17.
Zurück zum Zitat M.V. Davi, L. Dalle Carbonare, A. Giustina, M. Ferrari, A. Frigo, V. Lo Cascio, G. Francia, Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur. J. Endocrinol. 159(5), 533–540 (2008)CrossRefPubMed M.V. Davi, L. Dalle Carbonare, A. Giustina, M. Ferrari, A. Frigo, V. Lo Cascio, G. Francia, Sleep apnoea syndrome is highly prevalent in acromegaly and only partially reversible after biochemical control of the disease. Eur. J. Endocrinol. 159(5), 533–540 (2008)CrossRefPubMed
18.
Zurück zum Zitat P. Pantanetti, N. Sonino, G. Arnaldi, M. Boscaro, Self image and quality of life in acromegaly. Pituitary 5(1), 17–19 (2002)CrossRefPubMed P. Pantanetti, N. Sonino, G. Arnaldi, M. Boscaro, Self image and quality of life in acromegaly. Pituitary 5(1), 17–19 (2002)CrossRefPubMed
19.
Zurück zum Zitat R. Trepp, R. Everts, C. Stettler, S. Fischli, S. Allemann, S.M. Webb, E.R. Christ, Assessment of quality of life in patients with uncontrolled vs. controlled acromegaly using the acromegaly quality of life questionnaire (AcroQoL). Clin. Endocrinol. 63, 103–110 (2005)CrossRef R. Trepp, R. Everts, C. Stettler, S. Fischli, S. Allemann, S.M. Webb, E.R. Christ, Assessment of quality of life in patients with uncontrolled vs. controlled acromegaly using the acromegaly quality of life questionnaire (AcroQoL). Clin. Endocrinol. 63, 103–110 (2005)CrossRef
20.
21.
Zurück zum Zitat M.P. Matta, E. Couture, L. Cazals, D. Vezzosi, A. Bennet, P. Caron, Impaired quality of life of patients with acromegaly: control of GH/IGF-I excess improves psychological subscale appearance. Eur. J. Endocrinol. 158(3), 305–310 (2008)CrossRefPubMed M.P. Matta, E. Couture, L. Cazals, D. Vezzosi, A. Bennet, P. Caron, Impaired quality of life of patients with acromegaly: control of GH/IGF-I excess improves psychological subscale appearance. Eur. J. Endocrinol. 158(3), 305–310 (2008)CrossRefPubMed
22.
Zurück zum Zitat A.N. Paisley, S.V. Rowles, M.E. Roberts, S.M. Webb, X. Badia, L. Prieto, S.M. Shalet, P.J. Trainer, Treatment of acromegaly improves quality of life, measured by AcroQol. Clin. Endocrinol. 67(3), 358–362 (2007)CrossRef A.N. Paisley, S.V. Rowles, M.E. Roberts, S.M. Webb, X. Badia, L. Prieto, S.M. Shalet, P.J. Trainer, Treatment of acromegaly improves quality of life, measured by AcroQol. Clin. Endocrinol. 67(3), 358–362 (2007)CrossRef
23.
Zurück zum Zitat M.A. Wagenmakers, S.H. Roerink, T.J. Maal, R.H. Pelleboer, J.W. Smit, A.R. Hermus, S.J. Berge, R.T. Netea-Maier, T. Xi, Three-dimensional facial analysis in acromegaly: a novel tool to quantify craniofacial characteristics after long-term remission. Pituitary 18(1), 126–134 (2015)CrossRefPubMed M.A. Wagenmakers, S.H. Roerink, T.J. Maal, R.H. Pelleboer, J.W. Smit, A.R. Hermus, S.J. Berge, R.T. Netea-Maier, T. Xi, Three-dimensional facial analysis in acromegaly: a novel tool to quantify craniofacial characteristics after long-term remission. Pituitary 18(1), 126–134 (2015)CrossRefPubMed
24.
Zurück zum Zitat M.D. Brennan, I.T. Jackson, E.E. Keller, E.R. Laws Jr., A.H. Sather, Multidisciplinary management of acromegaly and its deformities. J. Am. Med. Assoc. 253(5), 682–683 (1985)CrossRef M.D. Brennan, I.T. Jackson, E.E. Keller, E.R. Laws Jr., A.H. Sather, Multidisciplinary management of acromegaly and its deformities. J. Am. Med. Assoc. 253(5), 682–683 (1985)CrossRef
25.
Zurück zum Zitat S.H. Roerink, M.A. Wagenmakers, J.F. Wessels, R.B. Sterenborg, J.W. Smit, A.R. Hermus, R.T. Netea-Maier, Persistent self-consciousness about facial appearance, measured with the Derriford appearance scale 59, in patients after long-term biochemical remission of acromegaly. Pituitary 18(3), 366–375 (2015)CrossRefPubMed S.H. Roerink, M.A. Wagenmakers, J.F. Wessels, R.B. Sterenborg, J.W. Smit, A.R. Hermus, R.T. Netea-Maier, Persistent self-consciousness about facial appearance, measured with the Derriford appearance scale 59, in patients after long-term biochemical remission of acromegaly. Pituitary 18(3), 366–375 (2015)CrossRefPubMed
26.
Zurück zum Zitat S.M. Webb, X. Badia, N.L. Surinach, Validity and clinical applicability of the acromegaly quality of life questionnaire, AcroQoL: a 6-month prospective study. Eur. J. Endocrinol. 155(2), 269–277 (2006)CrossRefPubMed S.M. Webb, X. Badia, N.L. Surinach, Validity and clinical applicability of the acromegaly quality of life questionnaire, AcroQoL: a 6-month prospective study. Eur. J. Endocrinol. 155(2), 269–277 (2006)CrossRefPubMed
27.
Zurück zum Zitat I. Kreitschmann-Andermahr, M. Buchfelder, B. Kleist, J. Kohlmann, C. Menzel, R. Buslei, M. Koltowska-Haggstram, C. Strasburger, S. Siegel, Predictors of quality of life in 165 patients with acromegaly: results from a single-center study. Endocr. Pract. 23(1), 79–88 (2017)CrossRefPubMed I. Kreitschmann-Andermahr, M. Buchfelder, B. Kleist, J. Kohlmann, C. Menzel, R. Buslei, M. Koltowska-Haggstram, C. Strasburger, S. Siegel, Predictors of quality of life in 165 patients with acromegaly: results from a single-center study. Endocr. Pract. 23(1), 79–88 (2017)CrossRefPubMed
28.
Zurück zum Zitat B.L. Herrmann, F. Mortsch, C. Berg, T. Weischer, C. Mohr, K. Mann, Acromegaly: a cross-sectional analysis of the oral and maxillofacial pathologies. Exp. Clin. Endocrinol. Diabetes 119(1), 9–14 (2011)CrossRefPubMed B.L. Herrmann, F. Mortsch, C. Berg, T. Weischer, C. Mohr, K. Mann, Acromegaly: a cross-sectional analysis of the oral and maxillofacial pathologies. Exp. Clin. Endocrinol. Diabetes 119(1), 9–14 (2011)CrossRefPubMed
29.
Zurück zum Zitat D. Karakis, B. Aktas-Yilmaz, A. Dogan, I. Yetkin, B. Bek, The bite force and craniofacial morphology in patients with acromegaly: a pilot study. Med. Oral Patol. Oral Cir. Bucal 19(1), e1–e7 (2014)CrossRefPubMed D. Karakis, B. Aktas-Yilmaz, A. Dogan, I. Yetkin, B. Bek, The bite force and craniofacial morphology in patients with acromegaly: a pilot study. Med. Oral Patol. Oral Cir. Bucal 19(1), e1–e7 (2014)CrossRefPubMed
30.
Zurück zum Zitat K. Kiseljak-Vassiliades, S. Shafi, J.M. Kerr, T.L. Phang, B.K. Kleinschmidt-DeMasters, M.E. Wierman, Clinical implications of growth hormone-secreting tumor subtypes. Endocrine 42(1), 18–28 (2012)CrossRefPubMed K. Kiseljak-Vassiliades, S. Shafi, J.M. Kerr, T.L. Phang, B.K. Kleinschmidt-DeMasters, M.E. Wierman, Clinical implications of growth hormone-secreting tumor subtypes. Endocrine 42(1), 18–28 (2012)CrossRefPubMed
31.
Zurück zum Zitat S. Melmed, G.D. Braunstein, E. Horvath, C. Ezrin, K. Kovacs, Pathophysiology of acromegaly. Endocr. Rev. 4(3), 271–290 (1983)CrossRefPubMed S. Melmed, G.D. Braunstein, E. Horvath, C. Ezrin, K. Kovacs, Pathophysiology of acromegaly. Endocr. Rev. 4(3), 271–290 (1983)CrossRefPubMed
32.
Zurück zum Zitat L. Katznelson, E.R. Laws Jr., S. Melmed, M.E. Molitch, M.H. Murad, A. Utz, J.A. Wass, S. Endocrine, Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014)CrossRefPubMed L. Katznelson, E.R. Laws Jr., S. Melmed, M.E. Molitch, M.H. Murad, A. Utz, J.A. Wass, S. Endocrine, Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014)CrossRefPubMed
33.
Zurück zum Zitat S. Bhayana, G.L. Booth, S.L. Asa, K. Kovacs, S. Ezzat, The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly. J. Clin. Endocrinol. Metab. 90(11), 6290–6295 (2005)CrossRefPubMed S. Bhayana, G.L. Booth, S.L. Asa, K. Kovacs, S. Ezzat, The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly. J. Clin. Endocrinol. Metab. 90(11), 6290–6295 (2005)CrossRefPubMed
34.
Zurück zum Zitat S.L. Fougner, O. Casar-Borota, A. Heck, J.P. Berg, J. Bollerslev, Adenoma granulation pattern correlates with clinical variables and effect of somatostatin analogue treatment in a large series of patients with acromegaly. Clin. Endocrinol. 76(1), 96–102 (2012)CrossRef S.L. Fougner, O. Casar-Borota, A. Heck, J.P. Berg, J. Bollerslev, Adenoma granulation pattern correlates with clinical variables and effect of somatostatin analogue treatment in a large series of patients with acromegaly. Clin. Endocrinol. 76(1), 96–102 (2012)CrossRef
35.
Zurück zum Zitat S. Yamada, T. Aiba, T. Sano, K. Kovacs, Y. Shishiba, S. Sawano, K. Takada, Growth hormone-producing pituitary adenomas: correlations between clinical characteristics and morphology. Neurosurgery 33(1), 20–27 (1993)PubMed S. Yamada, T. Aiba, T. Sano, K. Kovacs, Y. Shishiba, S. Sawano, K. Takada, Growth hormone-producing pituitary adenomas: correlations between clinical characteristics and morphology. Neurosurgery 33(1), 20–27 (1993)PubMed
36.
Zurück zum Zitat N.C. Bavbek, B.B. Tuncer, C. Tuncer, K. Gungor, C. Ozkan, E. Arslan, A.E. Altinova, M. Akturk, F.B. Toruner, Cephalometric assessment of soft tissue morphology of patients with acromegaly. Aust. Orthod. J. 32(1), 48–54 (2016)PubMed N.C. Bavbek, B.B. Tuncer, C. Tuncer, K. Gungor, C. Ozkan, E. Arslan, A.E. Altinova, M. Akturk, F.B. Toruner, Cephalometric assessment of soft tissue morphology of patients with acromegaly. Aust. Orthod. J. 32(1), 48–54 (2016)PubMed
37.
Zurück zum Zitat M. Gosau, C. Vogel, A. Moralis, P. Proff, J. Kleinheinz, O. Driemel, Mandibular prognathism caused by acromegaly—a surgical orthodontic case. Head Face Med. 5, 16 (2009)CrossRefPubMedPubMedCentral M. Gosau, C. Vogel, A. Moralis, P. Proff, J. Kleinheinz, O. Driemel, Mandibular prognathism caused by acromegaly—a surgical orthodontic case. Head Face Med. 5, 16 (2009)CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat S. Melmed, F.F. Casanueva, A. Klibanski, M.D. Bronstein, P. Chanson, S.W. Lamberts, C.J. Strasburger, J.A. Wass, A. Giustina, A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 16(3), 294–302 (2013)CrossRefPubMed S. Melmed, F.F. Casanueva, A. Klibanski, M.D. Bronstein, P. Chanson, S.W. Lamberts, C.J. Strasburger, J.A. Wass, A. Giustina, A consensus on the diagnosis and treatment of acromegaly complications. Pituitary 16(3), 294–302 (2013)CrossRefPubMed
39.
Zurück zum Zitat M. Agrawal, N. Maitin, K. Rastogi, R. Bhushan, Seeing the unseen: diagnosing acromegaly in a dental setup. BMJ Case Rep. 2013, 1–3 (2013). M. Agrawal, N. Maitin, K. Rastogi, R. Bhushan, Seeing the unseen: diagnosing acromegaly in a dental setup. BMJ Case Rep. 2013, 1–3 (2013).
Metadaten
Titel
Oro-dental pathologies in acromegaly
verfasst von
Ilonka Kreitschmann-Andermahr
Johannes Kohlmann
Bernadette Kleist
Ursula Hirschfelder
Rolf Buslei
Michael Buchfelder
Sonja Siegel
Publikationsdatum
08.03.2018
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 2/2018
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-018-1571-y

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