A 53-year-old man with acromegaly was referred for neurosurgical treatment. At admission: GH 240 ME/l at all time points of glucose tolerance test, IGF1 415.1 ng/ml, brain MRI showed pituitary adenoma 34×32×27 mm extending suprasellar, deforming and displacing optic chiasm, parasellar to both cavernous sinuses and surrounding left internal carotid artery. Clinical blood tests revealed marked erythrocytosis 6.1×1012, Hb 200 g/l, HCT 62%; urobilinigen 50 mmol/l was found in urine; otherwise the tests were normal. For exclusion of erythraemia the patient underwent trepanobiopsy of bone marrow which showed normal haemopoesis and suggested a secondary nature of erythrocytosis. In preoperative period 1100 ml of blood were evacuated by phlebotomy in 6 sessions, which resulted in reduction of erythrocyte count to 5.1×1012, Hb 160 g/l, HCT 50% and disappearance of urobilinigen. The patient was then operated by transnasal approach with debulking of most adenomatous tissue but without biochemical remission of acromegaly (GH 9299 at glucose tolerance test). A week after surgery erythrocytes 4.5×1012, Hb 141 g/l, HCT 44.1%. The patient was prescribed a octreotide depo injections 20 mg/mth and at 6 months from operation was feeling well, with clinical remission and normalization of IGF1 and all blood count parameters.
This is the first clinical observation of a secondary erythrocytosis in an acromegalic patient to the best of knowledge of authors.
30 Apr - 04 May 2011
European Society of Endocrinology