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

Yıl 2017, Cilt: 9 Sayı: 2, 98 - 102, 02.03.2017
https://doi.org/10.21601/ortadogutipdergisi.291977

Öz

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 pain
3 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.

Kaynakça

  • CapatinaC, Wass JA. 60 years of Neuroendocrinology:Acromegaly. Journal of Endocrinology 2015; 226:141-160.(doi:10.1530/JOE-15-0109)
  • Holdaway IM, Bolland MJ, Gamble GD. A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. European Journal of Endocrinology 2008;159: 89-95.(doi:10.1530/EJE-08-0267)
  • Sherlock M, Ayuk J, Tomlinson JW, et al. Mortality in patients with pituitary disease. Endocrine Reviews 2010;31:301-342.(doi:10.1210/er.2009-0033)
  • Ezzat S, Melmed S. Clinical review 18: are patients with acromegaly at increased risk for neoplasia? J Clin Endocrinol Metab 1991;72: 245–249.
  • Jenkins PJ, Besser M. Clinical perspective: acromegaly and cancer: a problem. J Clin Endocrinol Metab 2001; 86:2935-2941.
  • Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of Acromegaly: epidemiology, pathogenesis, and management. Endocrine Reviews 2004;25:102-152.
  • Loeper S, Ezzat S. Acromegaly: re-thinking the cancer risk. Reviews in Endocrine and Metabolic Disorders 2008; 9:41-58.
  • Melmed S. Acromegaly and cancer: not a problem? Journal of Clinical Endocrinology and Metabolism 2001 86: 2929-2934.
  • P. J. Jenkins, V. Frajese, A-M. Jones, et al. Insulin-Like Growth Factor I and the Development of Colorectal Neoplasia in Acromegaly. J Clin Endocrinol Metab. 2000 Sep;85(9):3218-21.
  • Boguszewski CL, Ayuk J. Management of endocrıne dısease: acromegaly and cancer: an old debate revısıted. Eur J Endocrinol. 2016 Apr 18. pii: EJE-16-0178. [Epubahead of print] PMID:27089890.
  • Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer Incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. Journal of Clinical Endocrinology and Metabolism 1998 83: 2730-2734.
  • Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly. Journal of Clinical Endocrinology and Metabolism 2004 89: 667-674.
  • Kopchick JJ, List EO, Kelder B, Gosney ES, Berryman DE. Evaluation of growth hormone(GH) action in mice: discovery of GH receptor antagonists and clinical indications. Molecular and Cellular Endocrinology 2014 386:34-45. (doi:10.1016/j.mce.2013.09.004)
  • Clayton PE, Banerjee I, Murray PG, Renehan AG. Growth hormone, the insulin- like growth factor axis, insulin and cancer risk. Nature Reviews Endocrinology 2011 7: 11-24. (doi:10.1038/nrendo.2010.171)
  • Chi F, Wu R, Zeng YC, XingR, LiuY. Circulation insulin-like growth factor peptides and colorectal cancer risk: an updated systematic review and meta-analysis. Molecular Biology Reports 2013 40: 3583-3590.(doi:10.1007/s11033-012-2432-z)
  • Aguiar-Oliveira MH, Oliveira FT, Pereira RM, etal. Longevity in untreated congenital growth hormone deficiency due to a homozygous mutation in the GHRH receptor gene. Journal of Clinical Endocrinology and Metabolism 2010 95: 714-721.(doi:10.1210/jc.2009-1879)
  • Guevara-Aguirre J, Balasubramanian P, Guevara-Aguirre M, et al. Growth hormone receptor deficiency is associated with a major reduction in pro-aging signaling, cancer and diabetes in humans. ScienceTranslational Medicine 2011 3: 70ra13.(doi:10.1126/scitranslmed.3001845)
  • Petroff D, Tönjes A, Grussendorf M, et al. The incidence of cancer among acromegaly patients: results from the German Acromegaly Registry. Journal of Clinical Endocrinology and Metabolism 2015 100 3894-3902. (doi:10.1210/jc.2015-2372)
  • Mercado M, Gonzalez B, Vargas G,et al. Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. Journal of Clinical Endocrinology and Metabolism. 2014 99:4438-4446.(doi:10.1210/jc.2014-2670)
  • Arosio M, Reimondo G, Malchiodi E, et al. Predictors of morbidity andmortality in acromegaly: an Italian survey. European Journal ofEndocrinology. 2012 167: 189-198.
  • Creutzfeldt W, Arnold R, Creutzfeldt C, Feurle G, Ketterer H. Gastrin and G-cells in the antral mucosa of patients with pernicious anaemia, acromegaly and hyperparathyroidism and in a Zollinger-Ellison tumour of the pancreas. Eur J Clin Invest. 1971 Sep;1(6):461-79.
  • Gallagher EJ, LeRoith D. Epidemiology and molecular mechanisms tying obesity, diabetes, and the metabolic syndrome with cancer. Diabetes Care 2013 36: Supp l2: S 233-9.(doi:10.2337/dcS13-2001)
  • Ezzat S, Ezrin C, Yamashita S, Melmed S. Recurrent acromegaly resulting from ectopic growth hormone gene expression by metastatic pancreatic tumor.Cancer. 1993 Jan 1;71(1):66-70.
  • Klöppel G, Maillet B. Classification and Staging of pancreatic Nonendocrine Tumors. Radiologic Clinics of North America 1989;27/1: 105-11.
  • Lillemoe KD. Current management of pancreatic carcinoma. Ann Surg 1995; 221: 133-148.
  • Vezeridis MP, Wanebo HJ. Pancreatic cancer in 1994: Diagnosis and treatment. R I Med 1994; 77: 115-118.
  • Warshaw AL, Fernandez-Del Castillo C. Pancreatic carcinoma. N Engl J Med 1992; 326: 455-464.
  • Norell SE, Ahlbom A, Erwald R, et al. Diet and pancreatic cancer: A case control study. Am J Epidemiol 1986; 124: 894-903.
  • Gold EB. Epidemiology of and risk factors for pancreatic cancer. Surg Clin North Am 1995; 75: 819-843.
  • Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. N Engl J Med 1993; 328: 1433-1437.
  • Hahn SA, Kern SE. Molecular genetics of exocrine pancreatic neoplasms. Surg Clin North Am 1995; 75: 857-869.
  • Barton CM, Staddon SL, Hall PA, et al. Abnormalities of the p53 tumour suppressor gene in human pancreatic cancer. Br J Cancer 1991; 64: 1076-1082.
  • Sakorafas GH, Tsiotou AG. Genetic basis of cancer of the pancreas: Diagnosis of therapeutic applications. Eur J Surg 1994; 160: 529-534.
  • Enrique Rozengurt, James Sinnett-Smith, KrisztinaKisfalvi. Crosstalk between Insulin/Insulin-likeGrowth Factor-1 Receptors and G Protein-Coupled Receptor Signaling Systems: A Novel Target for the Antidiabetic Drug Metformin in Pancreatic Cancer. Clin Cancer Res 2010;16:2505-2511.
  • Chong CR, Chabner BA. Mysterious Metformin. Oncologist 2009;14: 1178–81.
  • Li D, Yeung S-CJ, Hassan MM, Konopleva M, Abbruzzese JL. Anti- diabetic therapies affect risk of pancreatic cancer. Gastroenterology 2009;137:482–8.

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

Yıl 2017, Cilt: 9 Sayı: 2, 98 - 102, 02.03.2017
https://doi.org/10.21601/ortadogutipdergisi.291977

Öz


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.


Kaynakça

  • CapatinaC, Wass JA. 60 years of Neuroendocrinology:Acromegaly. Journal of Endocrinology 2015; 226:141-160.(doi:10.1530/JOE-15-0109)
  • Holdaway IM, Bolland MJ, Gamble GD. A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. European Journal of Endocrinology 2008;159: 89-95.(doi:10.1530/EJE-08-0267)
  • Sherlock M, Ayuk J, Tomlinson JW, et al. Mortality in patients with pituitary disease. Endocrine Reviews 2010;31:301-342.(doi:10.1210/er.2009-0033)
  • Ezzat S, Melmed S. Clinical review 18: are patients with acromegaly at increased risk for neoplasia? J Clin Endocrinol Metab 1991;72: 245–249.
  • Jenkins PJ, Besser M. Clinical perspective: acromegaly and cancer: a problem. J Clin Endocrinol Metab 2001; 86:2935-2941.
  • Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of Acromegaly: epidemiology, pathogenesis, and management. Endocrine Reviews 2004;25:102-152.
  • Loeper S, Ezzat S. Acromegaly: re-thinking the cancer risk. Reviews in Endocrine and Metabolic Disorders 2008; 9:41-58.
  • Melmed S. Acromegaly and cancer: not a problem? Journal of Clinical Endocrinology and Metabolism 2001 86: 2929-2934.
  • P. J. Jenkins, V. Frajese, A-M. Jones, et al. Insulin-Like Growth Factor I and the Development of Colorectal Neoplasia in Acromegaly. J Clin Endocrinol Metab. 2000 Sep;85(9):3218-21.
  • Boguszewski CL, Ayuk J. Management of endocrıne dısease: acromegaly and cancer: an old debate revısıted. Eur J Endocrinol. 2016 Apr 18. pii: EJE-16-0178. [Epubahead of print] PMID:27089890.
  • Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer Incidence in acromegaly: a retrospective cohort study. United Kingdom Acromegaly Study Group. Journal of Clinical Endocrinology and Metabolism 1998 83: 2730-2734.
  • Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly. Journal of Clinical Endocrinology and Metabolism 2004 89: 667-674.
  • Kopchick JJ, List EO, Kelder B, Gosney ES, Berryman DE. Evaluation of growth hormone(GH) action in mice: discovery of GH receptor antagonists and clinical indications. Molecular and Cellular Endocrinology 2014 386:34-45. (doi:10.1016/j.mce.2013.09.004)
  • Clayton PE, Banerjee I, Murray PG, Renehan AG. Growth hormone, the insulin- like growth factor axis, insulin and cancer risk. Nature Reviews Endocrinology 2011 7: 11-24. (doi:10.1038/nrendo.2010.171)
  • Chi F, Wu R, Zeng YC, XingR, LiuY. Circulation insulin-like growth factor peptides and colorectal cancer risk: an updated systematic review and meta-analysis. Molecular Biology Reports 2013 40: 3583-3590.(doi:10.1007/s11033-012-2432-z)
  • Aguiar-Oliveira MH, Oliveira FT, Pereira RM, etal. Longevity in untreated congenital growth hormone deficiency due to a homozygous mutation in the GHRH receptor gene. Journal of Clinical Endocrinology and Metabolism 2010 95: 714-721.(doi:10.1210/jc.2009-1879)
  • Guevara-Aguirre J, Balasubramanian P, Guevara-Aguirre M, et al. Growth hormone receptor deficiency is associated with a major reduction in pro-aging signaling, cancer and diabetes in humans. ScienceTranslational Medicine 2011 3: 70ra13.(doi:10.1126/scitranslmed.3001845)
  • Petroff D, Tönjes A, Grussendorf M, et al. The incidence of cancer among acromegaly patients: results from the German Acromegaly Registry. Journal of Clinical Endocrinology and Metabolism 2015 100 3894-3902. (doi:10.1210/jc.2015-2372)
  • Mercado M, Gonzalez B, Vargas G,et al. Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. Journal of Clinical Endocrinology and Metabolism. 2014 99:4438-4446.(doi:10.1210/jc.2014-2670)
  • Arosio M, Reimondo G, Malchiodi E, et al. Predictors of morbidity andmortality in acromegaly: an Italian survey. European Journal ofEndocrinology. 2012 167: 189-198.
  • Creutzfeldt W, Arnold R, Creutzfeldt C, Feurle G, Ketterer H. Gastrin and G-cells in the antral mucosa of patients with pernicious anaemia, acromegaly and hyperparathyroidism and in a Zollinger-Ellison tumour of the pancreas. Eur J Clin Invest. 1971 Sep;1(6):461-79.
  • Gallagher EJ, LeRoith D. Epidemiology and molecular mechanisms tying obesity, diabetes, and the metabolic syndrome with cancer. Diabetes Care 2013 36: Supp l2: S 233-9.(doi:10.2337/dcS13-2001)
  • Ezzat S, Ezrin C, Yamashita S, Melmed S. Recurrent acromegaly resulting from ectopic growth hormone gene expression by metastatic pancreatic tumor.Cancer. 1993 Jan 1;71(1):66-70.
  • Klöppel G, Maillet B. Classification and Staging of pancreatic Nonendocrine Tumors. Radiologic Clinics of North America 1989;27/1: 105-11.
  • Lillemoe KD. Current management of pancreatic carcinoma. Ann Surg 1995; 221: 133-148.
  • Vezeridis MP, Wanebo HJ. Pancreatic cancer in 1994: Diagnosis and treatment. R I Med 1994; 77: 115-118.
  • Warshaw AL, Fernandez-Del Castillo C. Pancreatic carcinoma. N Engl J Med 1992; 326: 455-464.
  • Norell SE, Ahlbom A, Erwald R, et al. Diet and pancreatic cancer: A case control study. Am J Epidemiol 1986; 124: 894-903.
  • Gold EB. Epidemiology of and risk factors for pancreatic cancer. Surg Clin North Am 1995; 75: 819-843.
  • Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. N Engl J Med 1993; 328: 1433-1437.
  • Hahn SA, Kern SE. Molecular genetics of exocrine pancreatic neoplasms. Surg Clin North Am 1995; 75: 857-869.
  • Barton CM, Staddon SL, Hall PA, et al. Abnormalities of the p53 tumour suppressor gene in human pancreatic cancer. Br J Cancer 1991; 64: 1076-1082.
  • Sakorafas GH, Tsiotou AG. Genetic basis of cancer of the pancreas: Diagnosis of therapeutic applications. Eur J Surg 1994; 160: 529-534.
  • Enrique Rozengurt, James Sinnett-Smith, KrisztinaKisfalvi. Crosstalk between Insulin/Insulin-likeGrowth Factor-1 Receptors and G Protein-Coupled Receptor Signaling Systems: A Novel Target for the Antidiabetic Drug Metformin in Pancreatic Cancer. Clin Cancer Res 2010;16:2505-2511.
  • Chong CR, Chabner BA. Mysterious Metformin. Oncologist 2009;14: 1178–81.
  • Li D, Yeung S-CJ, Hassan MM, Konopleva M, Abbruzzese JL. Anti- diabetic therapies affect risk of pancreatic cancer. Gastroenterology 2009;137:482–8.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Vaka sunumu
Yazarlar

Aşkın Güngüneş

Şenay Arıkan Durmaz

Dilek Oğuz

Selim Yalçın

Nesrin Turhan Bu kişi benim

Aydın Çifci Bu kişi benim

Yayımlanma Tarihi 2 Mart 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 9 Sayı: 2

Kaynak Göster

Vancouver Güngüneş A, Arıkan Durmaz Ş, Oğuz D, Yalçın S, Turhan N, Çifci A. Akromegali ve pankreas adenokarsinomunun insidental birlikteliği olan nadir bir vaka; Olgu sunumu. otd. 2017;9(2):98-102.

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