A case of acromegaly in the presence of coincidental liver cirrhosis

S. Topsakal; F. Akin; E. Yerlikaya; T. Korkmaz

Acromegaly is a rare and serious syndrome and commonly associated with pituitary neoplasm. Classic cause of acromegaly in adults is the tumors of the somatotrophs that secrete growth hormone. Cirrhosis is the end stage of chronic liver disease and commonly cause of death. It is characterized by diffuse hepatic fibrosis resulting in altered construction of the lobular parenchyma with widespread connective tissue septae, circumscribed regenerative nodules of hepatocytes and anastomoses between vascular channels linking portal and central vessels. A 62-year old, male patient came to the hospital complaining of severe abdominal swelling. Laboratory and imaging findings were compatible with the presence hepatitis B virus related cirrhosis together with acromegaly. In this case, he had high GH level but lower IGF1 level because of hepatic failure which can impair IGF1 production by the liver. Definitive diagnosis was made by pituitary MR and 1 cm in diameter tumor was detected. This paper showed that cirrhosis can result in a low IGF1 level in patients with acromegaly. There is no previous report available of the in the presence of coincidental combination of acromegaly and cirrhosis in a patient.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Laboratory findings, hormon profiles and hepatitis markers of the acromegalic patient with cirrhosis.
	At admission	Follow up (6 months later)	Reference
Glu (mg/dl)	87	289	80–115
Cr (mg/dl)	0.6	1.05	0.7–1.2
Na (mg/dl)	141	136	136–145
K (mg/dl)	4	4.1	3.5–5.1
Total bil (mg/dl)	2.39	2.28	0.2–1.2
Direct bil (mg/dl)	1.06	1.25	0–0.5
Prot (g/dl)	6.3	5.8	6–8
Alb (g/dl)	2.8	2.3	3.5–5
AST (IU/l)	104	114	5–35
ALT (IU/l)	35	86	10–50
WBC (K/μl)	4.37	4.35	3.6–9.4
Hgb (g/dl)	11.9	10.2	13–17.5
Plt (K/μl)	47.9	49.8	142–424
Protrombin time	%62	%34	70–130
HBsAg (S/CO)	>250.00	>250.00	<0.9
Anti HBs (mIU//ml)	2.06	2.06	<7
GH (ng/ml)	15.4	51.4	0–1
IGF1 (ng/ml)	50.3	71.7	71–290

Endocrine Abstracts

P1534