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This version published online on October 28, 2009
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-1172
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Submitted on June 2, 2009
Accepted on August 31, 2009

The Exon-3 Deleted Growth Hormone Receptor Polymorphism Predisposes to Long-Term Complications of Acromegaly

M. J. E. Wassenaar, N. R. Biermasz*, A. M. Pereira, A. A. van der Klaauw, J. W. A. Smit, F. Roelfsema, T. van der Straaten, M. Cazemier, D. W. Hommes, H. M. Kroon, M. Kloppenburg, H.-J. Guchelaar, and J. A. Romijn

Departments of Endocrinology and Metabolic Diseases (M.J.E.W., N.R.B., A.M.P., A.A.v.d.K., J.W.A.S., F.R., J.A.R.), Clinical Epidemiology (M.K.), Rheumatology (M.K.), Gastroenterology (D.W.H.), Clinical Pharmacy and Toxicology (T.v.d.S., H.-J.G.), and Radiology (H.M.K.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands; and Department of Gastroenterology (M.C.), Bronovo Hospital, 2509 JH The Hague, The Netherlands

* To whom correspondence should be addressed. E-mail: n.r.biermasz{at}lumc.nl.

Objective: The aim of the study was to evaluate the impact of the genomic deletion of exon 3 of the GH receptor (d3GHR) on long-term clinical outcome of acromegaly in a well-characterized cohort of patients with long-term remission of acromegaly.

Design: We conducted a cross-sectional study.

Methods: The presence of the d3GHR polymorphism was assessed in 86 acromegalic patients with long-term disease control and related to anthropometric parameters, cardiovascular risk factors, osteoarthritis, bone mineral density, colonic polyps and diverticulae, and dolichocolon.

Results: Fifty-one patients had two wild-type alleles (59%), whereas 29 patients (34%) had one allele and six patients (7%) had two alleles encoding for the d3GHR isoform. Carriers of the d3GHR isoform showed increased prevalence of osteoarthritis, especially of the hip [adjusted odds ratio (OR), 5.2; 95% confidence interval (CI), 3.2–7.1], of adenomatous polyps (adjusted OR, 4.1; 95% CI, 2.4–5.6), and dolichocolon (adjusted OR, 3.2; 95% CI, 1.8–4.6). Anthropometric parameters, cardiovascular risk factors, bone mineral density, and (non)vertebral fractures were not significantly different between patients with and without the d3GHR allele.

Conclusion: In patients with long-term cured acromegaly, the d3GHR polymorphism is associated with an increased prevalence of irreversible comorbidities such as osteoarthritis, dolichocolon, and adenomatous colonic polyps, but not with other comorbidities such as cardiovascular risk factors.







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