Endocrine Abstracts

Introduction: Acromegaly is a chronic disease caused by excess growth hormone (GH) release from an adenoma caused by somatotroph cells of pituitary gland.In acromegaly, it is known that the risk of thyroid and colon cancer is increased 8 and 4 times, respectively, compared to the normal population.Moderate hypercalcemia, due to vitaminD activation, is seen in acromegaly, but overt hypercalcemia, generally secondary to primary hyperparathyroidism, is rare.Combination of acromegaly and primary hyperparathyroidism, often related with MEN-1 (Multiple endocrine neoplasia-1), has been reported in few cases.In this study, we wanted to share a newly diagnosed acromegaly with diabetes mellitus, multinodular goiter, primary hyperparathyroidism, and colon cancer.

Case: A 60-year-old male with hypertension and coronary artery disease was referred to our endocrinology clinic because of supressed TSH (thyroid stimulating hormone) level.As a result of examinations, he had been diagnosed with diabetes mellitus, multinodular goiter, and primary hyperparathyroidism.Because of his enlarged hands, feet and acromegalic face IGF-1 (insulin-like growth factor-1) was evaluated.Due to high IGF-1 level, glucose growth hormone suppression test (GGHST) was performed.GH was not supressed, compatible with acromegaly.Pituitary magnetic resonance imaging (MRI) revealed 14 × 10 mm nodular lesion in inferior part of pituitary gland, no cavernous sinus and optic chiasm compression were observed.Thyroid USG (ultasonography) revealed diffuse hyperplasic thyroid gland, with multinodular goiter, and a 22.8 × 12.8 × 57.8 mm hypoechoic lesion, suggested parathyroid adenoma, adjacent to the right superior thyroid lobe.Thyroid scintigraphy revealed active multinodular lesions on the upper left lobe of the thyroid gland, and parathyroid scintigraphy showed activity retention in the area that fit the thyroid gland in the right upper-middle section that could be compatible with parathyroid pathology.Fine needle aspiration biopsy (FNAB) of recommended thyroid nodules were reported as benign and nondiagnostic.Bone mineral densitometry was compatible with osteopenia, nephrolithiasis was reported on abdomen USG.Due to co-existence of acromegaly and primary hyperparathyroidism, MEN-1 was evaluated, genetic test was normal.His colonoscopy revealed 3–4 cm ulcer in rectum, and the biopsy result was adenocarcinoma.The patient was evaluated in terms of current diagnoses, operation for acromegaly and primary hyperparathyroidism was planned, but since it was stated by the oncology department that the operation for colon cancer is a priority for patient survival, the operation for colon cancer was planned first.Lanreotide for acromegaly, zoledronic acid for primary hyperparathyroidism were given.Since the patient wanted to be operated in the another center, he was discharged to apply after the operation.

Conclusion: Acromegaly causes an increased morbidity and mortality with metabolic effects caused by GH over-secretion and the mass effect due to compression of the pituitary adenoma.In the course of acromegaly, patients should be examined appropriately for possible complications.Acromegalic cases with hypercalcemia should be evaluated for parathyroid adenoma and possible MEN-1-syndrome, although it is not common.