A rare case with incidental coexistence of acromegaly and pancreatic adenocarcinoma; Case report

Year 2017, , 98 - 102, 02.03.2017

Aşkın Güngüneş , Şenay Arıkan Durmaz , Dilek Oğuz , Selim Yalçın , Nesrin Turhan Aydın Çifci

https://doi.org/10.21601/ortadogutipdergisi.291977

Abstract

Acromegaly is a rare
endocrine disease. Acromegalyis associated with an increased prevalence of
colorectal cancer and  pre-malignant
tubularadenomas, and also may be associated with other organ malignancies such as breast
and thyroid.                 In this
article, were reported rare case in th elight of  coexistence of  acromegaly and incidental pancreatic
adenocarcinoma.

A52-year-old man who was diagnosed with acromegaly
about two
years ago.After diagnosis, transsphenoidal surgery was performed. After surgery
serum growth hormone (GH)
and insulin-like growth factor 1 (IGF-1) levels was not return to normal,
therefore somatostatin
analog treatment was started. After this treatment,
serum IGF-1 concentration was normal
for age and gender. He was admitted to
out-patient clinic with abdominal pain3 month ago. 44x26 mm mass lesion
in the tail of the pancreas and multiple metastatic lesions in the
liver were detected on abdomen computed tomography (CT).
Erosive gastritis and polyps in the colon were observed on upper
gastrointestinal endoscopy and colonoscopy, respectively. Endoscopic
ultrasound-guided fineneedle aspiration biopsy was performed to the mass
lesions in the tail of the pancreas. Pathological
examination was consistent with ductal adenocarcinoma arising from the
pancreas.

Thepatients with acromegaly have
an increased risk of
benign and malignant neoplasms, these situation may be related with increased
circulating levels of IGF-1. IGF-1 have proliferative and anti-apoptotic
activity. The coexistence of acromegaly and metastatic pancreatic tumor was
present in the literature but it is quite rare. It is necessary to consider
that pancreatic adenocarcinoma and other malignant diseases may present in
acromegaly patients.

Keywords

Acromegaly, ductal pancreatic adenocarcinoma, GH, IGF-1

Akromegali ve pankreas adenokarsinomunun insidental birlikteliği olan nadir bir vaka; Olgu sunumu

Abstract

Akromegali nadir bir endokrin hastalıktır. Akromegali, premalign tübüler
adenom ve kolorektal kanser sıklığında artış ile ilişkili olup meme ve tiroid
gibi diğer organ maligniteleriyle de ilişkili olabilir. Bu yazıda, tarafımızca
akromegali ve pankreas adenokarsinom insidental birlikteliği ışığında nadir görülen
bir vakanın bildirimi yapıldı.

Elli iki yaşında
erkek hasta, yaklaşık 2 yıl önce akromegali tanısı aldı. Tanı sonrası transsfenoidal cerrahi uygulandı. Cerrahi
sonrası büyüme hormonu (GH) ve insülin benzeri büyüme faktörü (IGF-1) düzeyleri
normale dönmeyen hastaya bu nedenle somatostatin analog tedavisi başlandı. Bu
tedaviyi takiben IGF-1 değeri yaş ve cinsiyete göre normale döndü. Aynı hasta 3 ay önce karın
ağrısı şikayeti ile polikliniğimize
başvurdu. Abdomen bilgisayarlı tomografide (BT) pankreas kuyruk kesiminde 44x26
mm boyutlarında kitle lezyonu ve karaciğerde çok sayıda metastatik lezyon
saptandı. Üst gastrointestinal sistem endoskopisi ve kolonoskopide sırasıyla
eroziv gastrit ve kolonda polipler gözlendi. Pankreas kuyruğundaki kitle
lezyonundan endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi
yapıldı. Patolojik inceleme pankreas kaynaklı duktal adenokarsinom ile uyumlu idi.

Akromegalisi olan hastalarda benign ve malign neoplazm
riskinde artış olup bu durum dolaşımdaki artmış IGF-1 düzeyleri ile ilişkili olabilir. IGF-1,
proliferatif ve anti-apoptotik etkinliğe sahiptir. Akromegali ve metastatik pankreatik tümör birlikteliği literatürde
yer almakla birlikte oldukça nadirdir. Akromegali hastalarında pankreas
adenokarsinomu ve diğer malign
hastalıkların olabileceğini dikkate almak gerekir.

Keywords

Akromegali, duktal pankreas adenokarsinomu, GH ve IGF-1

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