Focus on renal morphology, chronic kidney disease, and urinary system malignancies in acromegaly: report on data collected over a 40-year period
Pituitary, vol.29, no.4, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 29 Issue: 4
- Publication Date: 2026
- Doi Number: 10.1007/s11102-026-01712-7
- Journal Name: Pituitary
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Keywords: Acromegaly, Chronic kidney disease, Growth hormone, IGF-1, Nephrolithiasis, Pituitary adenoma, Renal cyst, Urinary neoplasm
- Hacettepe University Affiliated: Yes
Abstract
Purpose: Long-term renal consequences of acromegaly remain poorly characterized. We assessed prevalence and independent predictors of renal cysts, chronic kidney disease (CKD), and the frequency of urinary-system malignancies, in a large acromegaly cohort. Methods: 394 acromegaly patients managed at a single tertiary center over four decades were retrospectively evaluated. Renal cyst and CKD predictors were identified by binary multivariate logistic regression with sensitivity analyses including IGF-1 exposure metrics; eGFR trajectories by nested analysis of covariance (ANCOVA). Standardized prevalence (SPRs) and incidence (SIRs) ratios were computed against age- and sex-stratified population references. Results: In 394 patients (202 male; median disease duration 17 years), renal cysts were present in 41.0% of imaged patients (47.4% bilateral), CKD in 16.1%, and nephrolithiasis in 15.1%. Among CKD patients, 64.9% had preserved eGFR (KDIGO G1–G2), reflecting albuminuria- or structure-driven ascertainment. Independent cyst predictors were age, nephrolithiasis, liver cysts, and multiple neoplasms; higher baseline potassium was inversely associated (OR 0.37, p = 0.013). Independent CKD predictors were age, male sex, hypertension, and nephrolithiasis. Cross-sectional and cumulative GH/IGF-1×ULN did not predict either outcome; cumulative IGF-1 was positively associated with follow-up eGFR (β=+1.69, p = 0.022), consistent with hyperfiltration. Age-matched SPRs were 1.23–1.98 for cysts (both p < 0.05) and 0.67 for CKD (p = 0.002); urinary-system cancers showed a > 7-fold excess (SIR 7.38, 2.97–15.20; p < 0.001). Conclusions: Renal cysts, CKD, and urinary-system malignancies are prevalent in acromegaly, with the long-term renal burden predominantly morphological and tubular rather than glomerular. Cross-sectional and cumulative GH/IGF-1 metrics did not predict CKD; age-matched CKD prevalence was lower than expected while cyst prevalence was elevated. The cyst and urinary-cancer excess support dedicated renal surveillance in long-term acromegaly management.