Palabras clave
enfermedad cardiovascular
hipertensión
diabetes mellitus
dislipidemias
hormona de crecimiento
Cómo citar
Resumen
Contexto: la acromegalia es una enfermedad rara causada principalmente por adenomas hipofisarios secretores de hormona del crecimiento (GH), la cual tiene múltiples manifestaciones sistémicas, entre las que el compromiso cardiovascular constituye la principal causa de morbilidad y mortalidad.
Objetivo: describir la epidemiología y la fisiopatología de la enfermedad cardiovascular en pacientes con acromegalia, así como revisar el impacto del control hormonal en este escenario.
Metodología: se realizó una búsqueda bibliográfica en PubMed, Scielo y Google Scholar hasta enero de 2025, utilizando los términos acromegalia, enfermedad cardiovascular, hipertensión, diabetes mellitus, dislipidemia, arritmia, valvulopatía, cardiomiopatía, enfermedad coronaria y enfermedad cerebrovascular. Se incluyeron artículos originales, ensayos clínicos, revisiones sistemáticas y metaanálisis. Se excluyeron publicaciones que no estuvieran disponibles en inglés o español.
Resultados: el exceso de la hormona del crecimiento e IGF-1 se asocia a una elevada prevalencia de comorbilidades cardiovasculares, como la hipertensión arterial, presente en el 50–64 % de los pacientes, seguida de la dislipidemia, que afecta a más del 60 %, y la diabetes mellitus, presente en aproximadamente el 30 %. Las arritmias cardíacas se presentan en el 7–40 % de los casos y las valvulopatías moderadas a severas en el 6–11 %, las cuales se asocian a hipertrofia ventricular y fibrosis miocárdica. El control bioquímico mediante cirugía o tratamiento farmacológico puede mejorar factores de riesgo como la presión arterial y el perfil lipídico; sin embargo, la evidencia sobre su impacto en la reducción de eventos cardiovasculares mayores es heterogénea.
Conclusiones: el compromiso cardiovascular en la acromegalia es frecuente y relevante. Aunque el control hormonal mejora algunos parámetros metabólicos, su efecto sobre desenlaces cardiovasculares mayores, como la muerte, el infarto agudo de miocardio y la enfermedad cerebrovascular, sigue siendo incierto. Se requiere un abordaje integral enfocado en el control hormonal y la optimización de factores de riesgo tradicionales, así como estudios prospectivos que definan con mayor claridad el impacto terapéutico en desenlaces clínicos significativos.
Citas
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