Acromegalic Uteropathy: Specific Uterine Ultrasound Findings in Female Patients

<b>Background/Objectives:</b> 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. <b>Methods:</b> We performed a retrospective case-control study of reproductive-age women who underwent pelvic ultrasound: acromegaly (<i>n</i> = 33), healthy controls (<i>n</i> = 45), and adenomyosis without acromegaly (<i>n</i> = 44). Uterine body measurements were obtained by TAUS/TVUS; cervical biometry was performed transvaginally in all cases. 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. <b>Results:</b> 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-values non-significant). 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 width, AP thickness, and volume, together with altered U:C indices, whereas cervical length did not differ, suggesting a pattern not explained by nonspecific pelvic pathology. <b>Conclusions:</b> Women with acromegaly demonstrate a distinct uterine phenotype characterized by selective cervical hypertrophy with preserved uterine corpus size-an ECM-centric "acromegalic uteropathy." This noninvasive morphometric signature may have diagnostic and procedural relevance and warrants confirmation in prospective studies.