Endocrine Abstracts

Acromegaly is a chronic condition associated with an increased risk of cancer.

Case presentation: A 41-year-old man admitted to our hospital with gluteal and scapular mass. He had a clinical history of acromegaly which had been diagnosed two years ago, and was treated with trans-sphenoidal surgery. After surgery, although remission was not achieved, he had no doctor visit and control. On physical examination he had typical acromegalic features and there was palpable mass on right gluteal and scapular region, which was noticed by the patient within the last two months. Laboratory examination revealed high levels of GH (10.8 ng/ml), IGF1 (1072 ng/ml). Abdominopelvic CT revealed an 93×68 mm mass on right kidney, 100×65 mm on the right gluteal region and 200×80 mm on the right scapular region. Thorax CT revealed metastatic nodüler lesions on the right lung. The diagnosis of metastatic renal clear cell cancer (RCC) was verified with gluteal and scapular biopsies. Pituitary MRI revealed residual makroadenoma (2 cm). Therapy for acromegaly with octreotide LAR was initiated. The patient underwent radiation therapy for the tumors of right scapular, gluteal region. At the same time patient recieved interferon-alfa therapy for metastatic RCC. After three months of treatment, scapular, gluteal mass regressed but renal mass and lung metastasis progressed with diffuse plevral effusion on the right side. Sunitinib treatment was started for the follow up.

Discussion: Therefore we report a very rare case of acromegaly with RCC. In adition to the increased circulating GH/IGF-1 levels, local expression of GHR and IGF-1/IGF-IR in the tumor tisues may partly contribute to the growth of multiple tumors. Type 1/IGF1R has an influence on renal cells malignant transformation by induction of cell proliferation, dediferantiation and antiapoptotic effect. The risk of RCC progression would have been very high had the acromegaly been left untreated. control of acromegaly is mandatory in acromegalic patients with cancer.