Acromegaly due to GHRH-secreting large bronchial carcinoid. Complete recovery following tumor surgery

Abstract

A case of acromegaly, secondary to GHRH secretion by a large bronchial carcinoid is reported. A 61-year-old woman presented with typical symptoms and signs of acromegaly for at least 10 years. She suffered from recurrent pneumonias, but repeated chest X-ray examinations failed to demonstrate the bronchial tumor. The diagnosis was confirmed by elevated GH, IGF-1 and GHRH secretion. We have shown an enlarged pituitary gland without focal lesions together with a cerebral meningioma on MRI and the presence of a bronchial carcinoid tumor. The latter was confirmed by histology carried out after bronchoscopy and tumor excision. We observed partial suppression of GH secretion following short-term oral bromocriptine administration in this patient. Surgical removal of the carcinoid tumor resulted in a complete clinical, hormonal and radiological cure of acromegaly. This case of acromegaly due to ectopic GHRH secretion by bronchial carcinoid differs from others described in the literature by an atypical large tumor size, the suppression of elevated GH secretion by oral bromocriptine and a concomitant meningioma.

Acromegaly caused by growth hormone-releasing hormone-producing tumors: long-term observational studies in three patients

“…During octreotide treatment no visible growth of (eventual) metastases was noted for many years with high-sensitivity liver CT scanning and CT scanning of the thorax in our patients, which suggests that in selected cases octreotide can inhibit growth of metastases from a carcinoid tumor. In addition, pituitary hyperplasia, the likely cause of the preoperative enlargement in patient 2, slowly disappeared completely, as previously described in other patients under medical therapy or after complete surgical removal of the GHRH source [ 27 , 54 ]. Nevertheless, in patient 3 GHRH levels increased slowly, suggesting growing metastasis under octreotide restraint.…”

Acromegalia ectópica por carcinoide bronquial

“…Los carcinoides bronquiales y gastrointestinales, seguidos por las neoplasias de células de los islotes pancreáticos son los que con más frecuencia causan excesiva secreción de GHRH 7 . Son más frecuentes en el sexo femenino, con una edad media de 40 años e historia de unos 10 años de evolución de la clínica acromegálica y afectando predominantemente el pulmón derecho con un tamaño medio de 1-2 cm 8 . La presencia de clínica adicional como disnea, pitidos torácicos, flushing facial, dispepsia y cálculos renales puede ayudar para sospechar patología extrahipofisaria.…”

Acromegaly secondary to an incidentally discovered growth-hormone-releasing hormone secreting bronchial carcinoid tumour associated to a pituitary incidentaloma

“…Indeed, from a biochemical view point only patients with hypothalamic or peripheral GHRH-secreting tumours show elevated circulating plasma GHRH levels, that may provide a precise and cost-effective diagnosis even if available only in few centres [9]. Moreover, markers of neuroendocrine tumours, such as chromogranin A (or gastrin), may be helpful to suspect an extra-hypothalamic source of GHRH [10].…”