The prolonged progressive course of acromegaly, complicated with diabetes mellitus, bilateral gonarthropathy, thyroid pathology and severe papillomatosis (clinical observation)
TS Kamynina, AV Dreval & JG Pokramovich
A patient, female, 53 years old was admitted for investigation and treatment of active acromegaly. At the age of 33 on the basis of the clinico-hormonal and CT investigations was diagnosed mixed pituitary adenoma - somatoprolactinoma. GH was 15.4 ng/ml (010 in healthy), prolactin (prl) 2000 ng/ml (<580 in healthy). The short course of parlodel therapy had no effect. At the age of 40, she was performed with transsphenoidal adenomectomy. Afterwards, diabetes mellitus (DM), severe gonarthropathy and multinodular goiter were revealed. At the age of 48, the relapse of somatotropinoma was diagnosed. The clinical symptoms of acromegaly persisted. The Parlodel treatment was used unconstantly.
On the basis of clinical, hormonal data and MRI we diagnosed somatotropinoma (size ∼2 sm). Blood hormones: GH 45.7 μIU (0.1613 in healthy), IGF-1 518 ng/ml (87238 the age range), prl 18 ng/ml (160500 in healthy). DM was classified as symptomatic (DM was absent among relatives). High daily Insulin doses (>100 U) and Siofor 850 mg 3 tab/day were used because of insulinoresistance. Severe bilateral gonarthrosis with decreased motility and multiple papillomatosis were diagnosed. The multinodular goiter was diagnosed by the thyroid ultrasonic. Thyroid volume was 30 ml. Two nodules (d≥2sm) nonhomogenic structure and low echogenicity were revealed. TSH achieved normal significance on replacement L-Thyroxin therapy. Somatulin treatment 30 mg/day/two times i/m each 2 wks was recommended.
In conclusion, we represented a case of acromegaly with multiple severe complications: symptomatic DM, multinodular goiter, with primary hypothyroidism, bilateral gonarthritis with decreased motility, multiple papillomatosis, developed in result of nonadequate treatment. The Somatulin therapy was started.