Acromegalic Uteropathy: Specific Uterine Ultrasound Findings in Female Patients

Background/Objectives: Acromegaly is a systemic connective-tissue disease driven by chronic growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess, yet the female reproductive tract—especially the extracellular matrix (ECM)-rich cervix—has been poorly studied. We aimed to compare uterine and cervical morphology in women with acromegaly versus healthy controls and a gynecologic disease comparator, testing the hypothesis of selective cervical hypertrophy. Methods: We performed a retrospective case–control study of reproductive-age women who underwent pelvic ultrasound: acromegaly (n=33), healthy controls (n=45), and adenomyosis without acromegaly (n=44). Uterine body and cervical length, width, and anteroposterior (AP) dimensions were measured transvaginally/transabdominally. Volumes were estimated using the ellipsoid formula, and a uterus-to-cervix (U:C) volume ratio was calculated. Group differences were analyzed with Mann–Whitney tests and Bonferroni correction. Results: A total of 122 women were included. Uterine body length, width, AP size, and volume did not differ between acromegaly and either comparison group (all p>0.1). In contrast, cervical length, width, AP thickness, and volume were significantly higher in acromegaly than in healthy controls, with a corresponding reduction in the U:C volume ratio, indicating disproportionate cervical enlargement. Compared with adenomyosis, women with acromegaly again showed larger cervical dimensions and altered U:C indices, suggesting a pattern not explained by nonspecific pelvic pathology. Conclusions: Women with acromegaly demonstrate a distinct uterine phenotype characterized by selective cervical hypertrophy with preserved uterine corpus size—an ECM-centric “acromegalic uteropathy.” This non-invasive morphometric signature may have diagnostic and procedural relevance and warrants confirmation in prospective studies.