Ectopic acromegaly due to growth hormone releasing hormone

Ghazi, Ali A.; Amirbaigloo, Alireza; Dezfooli, Azizollah Abbasi; Saadat, Navid; Ghazi, Siavash; Pourafkari, Marina; Tirgari, Farrokh; Dhall, Dheepti; Bannykh, Serguei; Melmed, Shlomo; Cooper, Odelia

doi:10.1007/s12020-012-9790-0

Cited by 59 publications

(47 citation statements)

References 99 publications

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“…Somatostatin analogues remain the treatment of choice for functional RF-p-NETs for the hormone excess state prior to surgery or if resection can not be performed, with recent reports of their effectiveness in PTHrPomas, ACTHomas, VIPomas GRFomas and other RF-p-NETs [5;27;190;196–198]. …”

Section: Medical Therapy Of F-p-nets (See Algorithm)mentioning

confidence: 99%

ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

et al. 2016

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Section: Medical Therapy Of F-p-nets (See Algorithm)mentioning

confidence: 99%

ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

et al. 2016

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“…Tumour resection was performed in 55 cases, somatostatin analogue therapy was given in 13 cases, and adjuvant chemotherapy and radiotherapy were used in 2 cases. Of these, 44% showed complete remission, 31% showed partial improvement, 5% did not show any improvement and 10% died 2. Antiangiogenic drugs and tyrosine kinase inhibitors are currently being investigated as potential treatments for NETs by inhibiting tumour growth 4 5.…”

Section: Discussionmentioning

confidence: 99%

“…Most ectopic-GHRH cases are due to lung carcinoid tumours, leading to hyperplasia of the pituitary and the resulting hyper-secretion of GH. Of all these cases, the mean age at diagnosis was 41 years, and 2/3 were female, similar to acromegaly caused by GH-secreting pituitary tumours 2. Failure to distinguish between pituitary and ectopic-acromegaly can lead to unnecessary major neurosurgery.…”

Section: Introductionmentioning

confidence: 96%

“…The pitfalls and difficulties lie in the fact that most patients with ectopic-acromegaly have pituitary hyperplasia visible on imaging that is radiologically difficult to distinguish from pituitary adenoma. Of the reported cases of ectopic-acromegaly, pituitary enlargement was noted in 75% of the cases and 1/3 of the patients underwent trans-sphenoidal surgery for presumed GH-secreting pituitary adenoma 2. Also, the time it takes for insulin-like growth factor-1 (IGF1) to normalise after resection of the GHRH-secreting tumour is unknown.…”

Section: Introductionmentioning

confidence: 99%

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‘Open-and-close’ pituitary surgery in an acromegalic man presenting with excessive sweatiness

Cheung

Chow

2016

BMJ Case Reports

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Ectopic-acromegaly is rare. Diagnosing ectopic-acromegaly is challenging given that the clinical and biochemical manifestations can be almost indistinguishable from those of patients with growth hormone secreting pituitary adenomas. This case report highlights the importance of clinical vigilance in differentiating between the two conditions. A 41-year-old Caucasian man presented with typical features of acromegaly with an enlarged pituitary and a lung lesion. Although excision of the lung mass showed a carcinoid tumour, normalisation of growth hormone factors did not occur soon enough. This led to a presumed diagnosis of a pituitary adenoma. However, no pituitary tumour was identified during trans-sphenoidal surgery. Postoperatively, the patient improved clinically and biochemically. Retrospective histological examination of the excised lung lesion showed a small proportion of tumour cells containing growth hormone releasing hormone (GHRH), suggesting ectopic-GHRH production from the lung neuroendocrine tumour. An open-and-close trans-sphenoidal surgery could have been avoided in this patient with ectopic-GHRH acromegaly.

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“…More rarely an ectopic source of GH related to abdominal or hematopoietic tumor may be the etiology of acromegaly [4,5]. In some cases, the source of excess of GH became a challenge when the investigations failed to identify the etiology of acromegaly.…”

Section: Introductionmentioning

confidence: 99%

Challenge of Dealing with Acromegalic Patient with Non-Culprit Lesion

Jemel¹

2017

J Clin Case Rep

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Acromegaly in commonly caused by GH secreting pituitary adenoma, which are a nearly always identifiable in conventional magnetic resonance (MRI). Rarely encountered, a patient with normal pituitary MRI, pose a diagnostic and therapeutic challenge. In this case a work up for ectopic acromegalic source of GH/GHRH should be considered. We herein report the case of a 60-year-old woman in whom we confirmed the GH excess. However, the imaging studies failed to identify the source of this pathology. Pituitary MRI failed to find an identifiable adenoma in MRI. The work up of ectopic GH/GHRH tumor was negative. In the lack of standard guidelines, our case is added to those reported in the literature to review the diagnostic challenge and management in such acromegalic patients.

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Ectopic acromegaly due to growth hormone releasing hormone

Cited by 59 publications

References 99 publications

ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

‘Open-and-close’ pituitary surgery in an acromegalic man presenting with excessive sweatiness

Challenge of Dealing with Acromegalic Patient with Non-Culprit Lesion

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