ACROMEGALY IN A PATIENT WITH MULTIPLE ENDOCRINE DISORDERS

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-191
Joana Menezes Nunes*1, Elisabete Rodrigues2, Eduardo Vinha3, M Ayres Basto4, L Castro4, Josué Pereira4 and Davide Carvalho3
1Centro Hosp Sao Joao, Porto, Portugal, 2Hosp Sao Joao, Porto, Portugal, 3Centro Hospitalar São João, Porto, Portugal, 4Centro Hosp São João
INTRODUCTION: Acromegaly is an endocrine disorder characterized by increased growth hormone (GH) secretion, resulting in more than 95% from a pituitary adenoma. It’s described the association between acromegaly and an increased incidence of neoplasms, namely in women, the most common one being thyroid carcinoma.

CASE REPORT: 45-year-old woman, Jehovha’s witness, with medical history notable for autosomal dominant polycystic kidney disease, referred to Endocrinology in 2004 for amenorrhea since 37 years olf, headaches and increased volume of hands and feet. Diagnostic work-up revealed acromegaly secondary to pituitary macroadenoma (Hardy Grade II) and she was submitted to transsphenoidal surgery. Histology confirmed a GH secreting tumour. The patient started treatment with somatostatin analogue for persistence of the disease. In 2006 she started dialysis and because of multinodular goiter carried out a fine needle biopsy of the biggest nodule with result of follicular lesion of undetermined significance. Total thyroidectomy was performed, in association with parathyroidectomy because of secondary hyperparathyroidism due to renal failure. Histology revealed follicular variant of papillary carcinoma 1.2 cm (pT1NxMx) and right parathyroid glands (120mg and 130mg) with clear cell predominance. She was referred for radioactive iodine (RAI) ablation (100mCi) and one week post-therapy RAI whole-body scan was negative. In 2007, type 2 diabetes mellitus was diagnosed and the patient was proposed for kidney transplation and referred to immuno hemotherapy consultation because of history of miscarriages and primary arteriovenous fistula failure. Heterozygous MTHFR gene mutation was discovered. So far, the patient remains clinically stable on follow-up, in peritoneal dialysis and on therapy with levothyroxine and somastostatin  analogue.

CONCLUSION: We describe this case because of the permanent diagnostic challenge and multiplicity of endocrine pathologies: acromegaly, thyroid carcinoma, diabetes mellitus, secondary and tertiary hyperparathyroidism.

S. Melmed, A. Colao, A. Barkan, M. Molitch, A. B. Grossman, D. Kleinberg,D. Clemmons, P. Chanson, E. Laws, J. Schlechte, M. L. Vance, K. Ho, and A. Giustina. Guidelines for Acromegaly Management: An Update. J Clin Endocrinol Metab, May 2009, 94(5):1509–1517P. Chanson, and S. Salenave. Acromegaly. Orphanet Journal of Rare Diseases, 2008, 3:17William D Fraser. Hyperparathyroidism. Lancet 2009; 374: 145–58Susan C. Pitt, Rebecca S. Sippel, and Herbert Chen. Secondary and Tertiary Hyperparathyroidism, State of the ArtSurgical Management. Surg Clin North Am. 2009 October ; 89(5): 1227–1239

Nothing to Disclose: JMN, ER, EV, MA, LC, JP, DC

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