Endocrine Abstracts (2017) 49 EP848 | DOI: 10.1530/endoabs.49.EP848

A rare case with acromegaly: increased hypophyseal FDG uptake in PET/CT performed for lung cancer staging

Veysi Asoglu1, Ece Celik2, Mehmet Celik3, Buket Yilmaz Bulbul3, Yusuf Durmus1, Semra Ayturk2, Funda Ustun4 & Sibel Guldiken3

1Department of Internal Medicine, Medical Faculty, Trakya University, Edirne, Turkey; 2Department of Chest Diseases, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey; 3Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, Edirne, Turkey; 4Department of Nuclear Medicine, Medical Faculty, Trakya University, Edirne, Turkey.

Acromegaly affects 4–6 people in a million and hypophyseal GH releasing adenoma is the most common cause of the disease. It shows its effects on GH and IGF1. Since they grow rapidly, they are usually diagnosed at the stage of macroadenomas. Heart failure, arthritis, OSAS and DM may develop during course of the disease. Although the most common accompanying malignancy is colon cancer, the incidence of malign melanoma, breast, thyroid, gastric and lung cancers is also increased. Increased hypophyseal Fluorine-18 fluorodeoxyglucose uptake is rare on positron emission tomography and computed tomography (FDG-PET/CT). Since hypophyseal adenomas may give false positive results on PET/CT, verification should be made by MRI. In this study, we aimed to present a case with increased FDG uptake in hypophysis and lung on PET/CT. 64-year male patient was presented with dyspnea and weight loss. Physical examination revealed prognatia, acral enlargement in hands and feet, dermal thickening and decreased breath sounds on apikal part of left lung. Chest X-ray and thoracic CT imagings demonstrated 2 cm sized nodular opacity in the upper lobe of the left lung. On FDG-PET/CT examination, increased FDG uptake was observed in this 2 cm sized nodular lesion in the lung and in 3 cm sized hypophyseal region. Hypophyseal MRI was performed and macroadenoma was detected. Ocular examination revealed hemianopsia. Laboratory examination findings were as follows: hemoglobin: 12.3 g/dl (13.7–17.5), sodiuum:140 mmol/l (normal: 135–145), potassium: 4.4 mmol/l, creatinin: 0.73 mg/dl, ACTH: 5 pg/ml (normal: 0–46), basal cortisol: 3.4 μg/dl (n:5–29), growth hormone: 2.25 ng/ml and IGF1: 440 ng/ml (n:70–212). Hypophyseal-thyroid and hypophyseal-gonadal axis were normal. GH levels measured 30-60-90 and 120 min after oral 75 g glucose tolerance test were 2.16, 1.65, 1.5 and 1.8, respectively. The patient was diagnosed with acromegaly and intramuscular octreotide 20 mg/month, prednisolone 5 mg in the morning and 2.5 mg in the evening were initiated before hypophyseal surgery. Left upper lobectomy of the left lung was performed and pathologic examination of surgical material revealed squamous cell carcinoma. Vinorelbine+cisplatin chemotherapy was initiated and the patient was scheduled for hypophyseal surgery.

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