Endocrine Abstracts

Introduction: Acromegaly is the set of clinical manifestations induced by chronic exposure to an endogenous excess of growth hormone (GH). Most often, acromegaly is related to GH production by a pituitary adenoma. It may be associated with neuroendocrine tumors of the pancreas as part of multiple endocrine neoplasia type 1 (MEN1). Herein, we described a tumor mimicking a carcinoma of the Ampulla of Vater in a patient with acromegaly.

Observation: A 54-year-old patient has an over 13-year history of acromegaly secondary to a pituitary macroadenoma of 21 mm with lateral extension to the left cavernous sinus. His acromegaly was complicated by diabetes mellitus, hypertension, colonic diverticulosis, and an EU-TIRADS III thyroid nodule. The patient underwent a transsphenoidal surgery that was complicated by transient central diabetes insipidus and a corticotropin deficiency. IGF-1 levels remained elevated postoperatively although the absence of residual tumor. Hence, monthly octreotide injections were prescribed complicated by a vesicular lithiasis operated 5 years ago. During follow up, the patient presented one year ago epigastralgia associated with jaundice, elevated liver enzymes and cholestasis. An abdominal MRI revealed ampullary carcinoma that was ruled out later histologically after pancreaticoduodenectomy.

Discussion: Acromegaly is a chronic, progressive and systemic disease that requires long-term treatment and follow up. Its association with a carcinoma of the Ampulla of Vater, which is a tumor with a poor prognosis, was not reported in the literature, contrary to the neuroendocrine tumors of the pancreas. A biopsy of the inflammatory tumor in our patient would prevent a major surgery.