Effect of pituitary microsurgery on acromegaly complicated nephrotic syndrome with focal segmental glomerulosclerosis: report of a rare clinical case.
A case of nephrotic syndrome complicated by acromegaly is presented. The first renal biopsy specimen showed minor glomerular abnormalities with glomerular hypertrophy, corresponding with minimal change nephrotic syndrome. Corticosteroid therapy led to a partial remission, followed by frequent relapses after reduction of the drug. A diagnosis of atypical focal segmental glomerulosclerosis (FSGS) was made based on the second renal biopsy results 6 months after the first. We combined steroid therapy with the administration of an anticoagulant, cytotoxic agents, angiotensin-converting enzyme inhibitor, and low-density lipoprotein adsorption. Except for the angiotensin-converting enzyme inhibitor, these medications were not effective in terms of allowing a reduction in the high dosage of steroid, which in turn threatened progressive osteoporosis and lumbar vertebrae fracture. Administering the steroid at a moderate dosage, treatment was focused on the complicating acromegaly from pituitary microadenoma. Subcutaneous injections of octreotide acetate, a somatostatin analogue, reduced proteinuria and increased urine volume. Subsequent transsphenoidal microsurgery of the adenoma resulted in the normalization of the elevated creatinine clearance and the further reduction in steroid dosage while maintaining a remission state. This is the first reported clinical case with acromegaly followed by FSGS, and it is suggested that hypersecretion of growth hormone participates in the development and progression of glomerular disease.
Yoshida
H
H
Departments of Pathology, Neurosurgery, and Postgraduate Medical Center, Chiba Social Insurance Hospital, Chiba, Japan. yosh915@green.ocn.ne.jp
Akikusa
B
B
Saeki
N
N
Hasegawa
S
S
Iesato
K
K
Yamamoto
S
S
Murotani
N
N
Wakashin
M
M
Shimada
T
T
D000172:Acromegaly / Q000150:complications / Q000601:surgery*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D005923:Glomerulosclerosis, Focal Segmental / Q000209:etiology*; D006801:Humans; D007016:Hypophysectomy; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008866:Microsurgery; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000188:drug therapy / Q000209:etiology*; D015282:Octreotide / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D007166:Immunosuppressive Agents; D011239:Prednisolone; D015282:Octreotide; D008775:Methylprednisolone