Endocrine Abstracts

Introduction: Acromegaly is a clinical syndrome caused by excessive production of growth hormone (GH). It is associated with an increase in the incidence of cancers. Through this observation, we illustrate the rare association of a somatotropic adenoma with a nasopharyngeal carcinoma.

Case report: 57-year-old woman, having hypertension, followed for an undifferentiated nasopharyngeal carcinoma since 2011 under radio-chemotherapy, having recurred in January 2018. A Magnetic resonance imaging of the cavum with a pituitary cut was made as part of the extension assessment having revealed: a macro non-compressive intra and supra-pituitary adenoma and asymmetry of the walls of the nasopharynx enhanced by the contrast product, probably due to radiotherapy. The patient was referred to our department for investigations. During her hospitalization, we noticed a clinical acromegaloid syndrome made of an excessive sweating and body odor, a husky voice, snoring, and enlarged hands, feet, tongue and facial features. The diagnosis of acromegaly was confirmed by a high level of insulin growth factor1 (IGF-1): 329.4 ng/mL (48–241 ng/mL). Currently she is a candidate for pituitary surgery.

Discussion: Excess chronic secretion of growth hormone causes an increase in IGF-1, which has a promotive role on mitogenesis and malignant proliferation of soft tissues and bones. Although there is no cause and effect relationship between acromegaly and neoplastic pathology, it is well established that hypersomatotropism is associated with an increased risk of neoplasms in many organs, such as the gastrointestinal tract, lungs, breast, prostate, kidney and brain that are the most aggressive and frequent. Nasopharyngeal carcinoma with pituitary damage remains a rare association with acromegaly, and raises the problem of differential diagnosis with the sellar metastasis of nasopharyngeal cancer.

Conclusion: An additional case of nasopharyngeal neoplasia in a patient with acromegaly reinforces the evidence of increased risk of developing cancer in these patients.