Endocrine Abstracts

Introduction: Acromegaly is a progressive disorder caused by excess growth hormone (GH), usually due to a GH-secreting pituitary adenoma, associated with an increased risk of cancer-related mortality. Insulin-like growth factor 1 (IGF-1) has been involved in tumor development by promoting cell proliferation and inhibiting apoptosis. Multiple myeloma (MM), a plasma cell neoplasm, has been suggested to have a potential link to IGF-1 in its pathogenesis.

Case report: This paper presents the case of a 51-year-old male diagnosed with acromegaly in 2018, with a pituitary macroadenoma (12/11/10 mm) that was surgically removed via a transsphenoidal approach. Postoperatively, the patient developed adrenal insufficiency and central hypothyroidism, necessitating corticosteroid and thyroid hormone substitution. Octreotide effectively controlled GH and IGF-1 levels until March 2022, when the treatment was switched to Lanreotide. Later, the patient experienced nonspecific thoracic pain, the thoracic radiography revealing a 7.3 cm mass in the right superior lateral-thoracic region. A thoracic MRI confirmed a 9 cm mass, later diagnosed as plasmacytoma following biopsy. Radiotherapy was initiated, and a bone marrow examination performed one month later revealed a cytological profile of a grade III A Durie Salmon multiple myeloma. The patient was treated with lenalidomide, low-dose dexamethasone, and bortezomib (VRd regimen) and was proposed for a bone marrow transplant.

Conclusions: Although acromegaly is associated with malignancy, its association with MM has not been thoroughly investigated. This case highlights the need for increased awareness of the potential association between these two conditions. Long-term surveillance and close monitoring of acromegaly patients are essential to detect and manage the development of secondary malignancies. This enables early intervention and improved patient outcomes, especially given the current lack of consensus on therapeutic guidelines and recommended prognosis for multiple myeloma coexisting with acromegaly.