Buccodental Manifestations in Patients With Acromegaly
Buccodental Manifestations in Patients With Acromegaly
Context: Acromegaly is the rare condition (3 to 4 new cases per million per year) due to
 Growth Hormone (GH) overproduction by a somatotrope pituitary adenoma, resulting in Insulin
 Growth Factor 1 (IGF-1) excess. Consequently, many tissues of the organism become
 hypertrophied. Hypertrophy of gingival and dental tissues can lead to alteration of oral
 health. However, there are very few published data concerning oral impact of acromegaly.

 Objective: To do the most accurate clinical and radiological state of oral manifestations in
 the series of prevalent acromegaly patients followed in the endocrinology service of the CHU
 of Clermont-Ferrand.
Context/ study relevance: Acromegaly is a rare condition (3 to 4 new cases per million per
 year) due to Growth Hormone (GH) overproduction by a somatotrope pituitary adenoma, resulting
 in Insulin Growth Factor 1 (IGF-1) excess. Consequently, a dysmorphic syndrome prevailing at
 the level of face and extremities progressively develops associated with potentially severe
 general manifestations (cardiovascular, respiratory and metabolic complications). Oral
 manifestations of acromegaly are not well known, there is very few published data on this
 topic and a controversy about the existence of a parodontal disease, i.e. the presence of
 gingival sulcus deepening which can lead to tooth loss. IGF-1 excess could lead to gingival
 hypertrophy and then to gingival sulcus deepening. Otherwise, the dental cementum, the only
 dental tissue which can grow during all lifetime, could be influenced by an excess of IGF-1.
 It is likely that acromegaly is associated with pathological cementum hypertrophy.

 Objective: To do the most accurate clinical and radiological state of oral manifestations in
 the series of prevalent acromegaly patients followed in the endocrinology service of the CHU
 of Clermont-Ferrand. Investigator will take a special interest in parodontal status i.e. the
 state of supporting tissues of the teeth and structural anomalies of dental cementum.

 As secondary objective, investigator would make a histological characterization of gingival
 and dental (cementum) tissues when a surgical treatment of the oral condition is required.
 Investigator will search hypertrophic anomalies linked with GH/IGF-1 excess.

 Material and methods: This is an observational, descriptive, cross-sectional, monocentric
 study conducted in the endocrinology/diabetology service of Clermont-Ferrand University
 Hospital (CHU), in France, where a series of about 70 prevalent acromegaly patients is
 annually followed. The participants will be adult acromegaly patients followed in this
 service, with proven diagnosis of acromegaly or previous acromegaly. They will be excluded of
 the study if they are totally toothless, if they take a medication associated with gingival
 hypertrophy if they are in a medical or chirurgical condition interacting with oral health so
 that the oral evaluation is not reliable or if there is no possibility of written informed
 consent. For each participant, investigator will collect demographic data and history of the
 pathology including previous and actual complications, biological tests results, imaging
 exams results and treatments. The participants will answer 3 questionnaires: AcroQol (quality
 of life in acromegaly patients), GOHAI (General Oral Health Assessment Index) and EPICES
 (evaluation of precariousness). The primary outcome will be a quantitative assessment of the
 oral health of the acromegalic patients with detailed assessment of 3 criteria:

 -  Depth of gingival sulcus measured for of all teeth

 -  CAO index (number of teeth with cavity or obturation or missing)

 -  Thickness of dental cementum on orthopantomogram and all other abnormality on this exam.

 The secondary outcome will be the histological analysis of gingival and dental tissues if
 available.

 All these measures will be taken during a routine odonto-stomatological consultation, part of
 the annual pathology evaluation at the endocrinology/diabetology service.
Inclusion Criteria:

 -  Adult acromegal patient followed in the endocrinology/diabetology service of the CHU
 of Clermont-Ferrand

 -  Proven diagnosis of acromegaly or previous acromegaly

 Exclusion Criteria:

 -  Minor subject

 -  Subject under guardianship or curatorship

 -  Total toothless patients

 -  No possibility of written informed consent

 -  Medical or chirurgical conditions interacting with oral health so that the oral
 evaluation is not reliable

 -  Medication associated with gingival hypertrophy