Endocrine Abstracts

Objective and importance: Among pathologies associated with acromegaly, have great importance both colon benignant neoformations such polyposis, and cardiovascular complications such as miocardic hypertrophy, arterial hypertension, coronaropathy and valvulopathy.

Clinical presentation: We report a case of 74-years-old woman with acromegaly, diabetes mellitus type II and hyperthyroidism, who was admitted at our clinic with symptoms of chronic febricula with episodes of high fever in excess of 39 °C, preceded by shaking chills and associated with profuse sweating and abdominal pains.

Interventions: The first diagnostic step excluded as a possible cause of clinical manifestations, both episodes of hypoglycaemia due to oral antidiabetic drugs, or hyperthyroidism breakthrough. Considering the positivity of haemocoltures for Steptococcus Bovis during fever’s spikes and the possible involvement of cardiac valves in acromegalic patients, a focused transthoracic echocardiogram was done. It showed a mitral valve prolapse and an hyperechogenic formation on the posterior limbus. Thus the diagnosis of bacterial endocarditis was concluded. After the resolution of the acute situation and when haemocoltures became negative, the patient, due to the presence of anaemia, was further subjected to a colonoscopy, which showed micropolyps of the transverse colon.

Conclusions: In literature the association between colon polyposis and bacteriaemia by S. Bovis was described. This pathogen would in fact provoke the release of pro-inflammatory cytokines (IL-8, PGE-2) responsible for the distruction of capillaries at the level of the newgrowth permitting as well as for the bacteria penetrating into the haematic circulation. Thus the diagnostic hypothesis is that acromegaly, in our patient, has in one hand favoured colon polyposis, allowing the proliferation of S. Bovis and its haematic diffusion, and on the other hand it has induced mitralic valvulopathy, rendering possible bacterium take on the valve limbus.