Is Acromegaly a hypercoagulable condition? Case reports and review of the literature

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 167-198-Hypothalamus-Pituitary Development & Biology
Basic/Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-186
Khaled M AlDahmani*1, Churn-Ern Yip1, David Anderson2, David B Clarke2 and Syed Ali Imran1
1Dalhousie University, Halifax, NS, Canada, 2Dalhousie University
Is Acromegaly a hypercoagulable condition? Case reports and review of the literature

KHALED AL DAHMANI1,CHURN-ERN YIP1, DAVID ANDERSON1, DAVID B CLARKE2, SYED ALI IMRAN1

Department of Medicine1 and the Division of Neurosurgery2, Dalhousie University, Halifax, Canada

Introduction:Uncontrolled acromegaly is associated with an increased risk of cardiovascular (CV) abnormalities such as hypertension, left ventricular hypertrophy, endothelial dysfunction and cardiomyopathy. In fact, CV complications constitute the leading cause of morbidity and mortality in patients with acromegaly. Recent reports have suggested that changes in coagulation and fibrinolytic system may also play a role in pathogenesis of CV disease in acromegaly. To date there are no published reports of an increased risk of venous thromboembolism (VTE) in uncontrolled acromegaly. We report three cases of uncontrolled acromegaly who presented with VTE. 

Clinical Cases:Case 1: A 52 yo male originally diagnosed with acromegaly in December 2009,  with elevated IGF-1 (15% >ULN) despite transspehnoidal surgery (TSP) and medical therapy presented in 2012 with acute chest pain and shortness of breath later confirmed as pulmonary embolism. Case 2: A 44 yo male immigrant to Canada was referred to endocrinology in 2007. He had been treated in his native country with radiation therapy only in 1992, but remained uncontrolled (IGF: 19% > ULN) despite medical therapy till 2009 when he achieved remission through TSP. He had several episodes of VTE between 2008 and 2010 including 2 episodes of right thigh superficial thrombophlebitis, 2 DVT's in his left leg great saphenous vein and popliteal vein and PE.  Case 3: A 69 yo male with uncontrolled acromegaly for 28 years (IGF-1: 196% >ULN) despite 2 surgical resections and radiation therapies in 1986 and 1992 as well as continuous medical therapy; presented in July 2011 with VTE of the right axiliary vein extending to the brachial vein and bilateral PE.

Preliminary thrombophilia screen in cases 1 and 3 was negative except for homozygous factor V leiden mutation in case 2. Further investigations showed no evidence of malignancy and echocardiography showed preserved ejection fraction in all 3 patients.

Conclusion: To our knowledge, these cases constitute the first reported clinical association between active acromegaly and the risk of VTE. Although a direct effect of GH or IGF-1 on the coagulation and fibrinolytic system has been reported, additional risks associated with acromegaly such as underlying malignancy, or congestive heart failure can also potentially contribute to these events. Further prospective studies should be conducted to assess this novel finding.

Nothing to Disclose: KMA, CEY, DA, DBC, SAI

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm