Since its original description by Pierre Marie in 1886, acromegaly has been known to be associated with an increased morbidity and mortality.1 Early epidemiological reviews showed this was due largely to diabetes mellitus and cardiovascular, cerebrovascular, and respiratory disease.1-4 In two early studies,3 ,4 the mean age of death was 57 years with 26% and 64%, respectively, of patients in one of these studies dying before the ages of 50 and 60 years.3 Recent reviews have suggested that these patients are also at increased risk of developing neoplasia, particularly colorectal cancer and tubulovillous adenomas,5-22 with one small prospective study reporting carcinomas in three of 12 patients (table 1).23 This is probably because more effective and aggressive treatment of both the underlying acromegaly and its metabolic and vascular complications has meant that patients are now surviving long enough to develop malignant complications of the disease.

We have recently confirmed that acromegaly predisposes to colonic neoplasia by performing a prospective colonoscopic evaluation of 155 patients.24 Colorectal carcinomas were present in 5% (eight patients) and at least one tubular adenoma in 25% (39 patients). Interestingly, only one patient with a carcinoma had gastrointestinal symptoms. Furthermore, three of the cancers occurred at the caecum, an unusual site for sporadic cancers in the non-acromegalic population. Two cancers were Dukes’ A, three Dukes’ B, two Dukes’ C, and one Dukes’ D. Although a number of factors were compared between those patients with neoplasia and those without, the only significant difference was that the former group were older than the unaffected patients (62 v 54 years) with the age of those with a carcinoma ranging from 58 to 74 years (median 64). Although there are no perfect control groups of …