Endocrine Abstracts

Introduction: It has been reported that patients with acromegaly have an increased risk of developing several types of cancers, including breast and thyroid. However, co-existence of thyroid and breast acncers in acromegaly is very rare. We describe a rare case of acromegaly associated with primary thyroid and breast cancers.

Case: A 63-year-old lady who presented to our endocrine clinic with complaints of increase in the size of her hands, feet, lips and nose for the past 10 years, during which time she had changed her ring size twice. She had a past medical history of breast cancer when she was 49, which was treated with wide local excision followed by radiotherapy. Her bloods showed high IGF-1, 99.6 nmol/l and growth hormone, 57.2 mIU/l (<5.1). OGTT with growth hormone levels confirmed the diagnosis of acromegaly. MRI of the pituitary showed pituitary macroadenoma with impending chiasmal compression. Trans-sphenoidal hypophysectomy was suggested and she was treated with Somatuline injections pre-operatively. While she was awaiting pituitary surgery, she was found to have thyroid nodule and right breast lump; FNA of the thyroid nodule and the right breast lump revealed papillary thyroid carcinoma (AC4) and recurrent breast carcinoma respectively. She subsequently right mastectomy followed by thyroidectomy. Six months later, trans-sphenoidal surgery for pituitary adenoma was performed. Post-operative MRI pituitary showed some residual tumor. She was restarted on somatuline injections and currently awaiting growth hormone suppression test off somatuline; she will be considered for stereotactic radiosurgery if there is evidence of active disease.

Comment: This case highlights the high risk of developing multiple neoplasms in patients with acromegaly. Routine screening procedures for malignancy, particularly for breast and thyroid cancers, should therefore be considered.