Endocrine Abstracts

Introduction: Acromegaly is a rare disease usually caused by growth hormone (GH) secreting pituitary adenomas (PA) and associated with a series of complications, including tumours. The most prevalent tumour types are colonic adenomas, colorectal cancer (1) and nodular goiter (2). We present two acromegaly cases attending our center that associate cervical cancer and another that associates melanoma.

Clinical cases:

Case 1: A 56-year-old female patient diagnosed with GH secreting PA underwent two transsphenoidal surgeries, gamma knife radiosurgery and required treatment with lanreotide, pegvisomant and cabergoline to achieve biochemical control. Eleven years after diagnosis, the patient developed postmenopausal metrorrhagia; Pap smear and endometrial biopsy described squamous carcinoma. The patient underwent radical hysterectomy and pelvic lymphadenectomy. Histopathogical report (HP) showed poorly differentiated cervical squamous cell carcinoma – radiotherapy and cisplatin were then recommended.

Case 2: A 34-year-old female patient diagnosed with GH secreting PA underwent transsphenoidal surgery, gamma knife radiosurgery and necessitated lanreotide, pegvisomant and cabergoline to achieve biochemical control. Four years after diagnosis, the patient had a successful spontaneous normal pregnancy, followed by regular spontaneous menstruation. Six years later, the patient became spontaneously pregnant again, but the gynecological exam identified a 40 mm cervix lesion. Biopsy showed moderately differentiated adenocarcinoma – the patient underwent second-trimester therapeutic abortion, neoadjuvant radiotherapy, radical hysterectomy and pelvic lymphadenectomy. HP described chronic inflammatory ulcerative process.

Case 3: A 40-year-old female patient diagnosed with mixed GH and prolacting secreting PA underwent transsphenoidal surgery, high-voltage radiotherapy and achieved biochemical control under pegvisomant and cabergoline. Eight years after diagnosis, dermatology consultation recommended excision of two scapulae nevi. HP described melanoma, Clark level II.

Conclusion: Exposure to high levels of GH and Insulin-like growth factor I in acromegaly are potential contributors to cancer pathogenesis by endocrine and paracrine mechanisms (3). Further epidemiological studies are required to establish whether acromegaly would be associated with increased risk for cancer other than colonic and thyroid. Thus, cancer screening programmes designed for the general population are to be thoroughly applied in acromegaly patients.

References: 1. Dworakowska, Dorota, and Ashley B. Grossman. “Colonic Cancer and Acromegaly.”Frontiers in Endocrinology, vol. 10, June 2019, https://doi.org/10.3389/fendo.2019.00390.

2. Vargas-Ortega, Guadalupe, et al. “Risk Factors Associated with Thyroid Nodular Disease in Acromegalic Patients: A Case-Cohort Study in a Tertiary Center.” Growth Hormone & IGF Research, vol. 60-61, Oct. 2021, p. 101431, https://doi.org/10.1016/j.ghir.2021.101431.

3. Kasuki, Leandro, et al. “Acromegaly and Colorectal Neoplasm: An Update.” Frontiers in Endocrinology, vol. 13, June 2022, https://doi.org/10.3389/fendo.2022.924952.