Acromegaly and pheochromocytoma: report of a rare coexistence.
OBJECTIVE
To describe a patient with the rare coexistence of acromegaly and pheochromocytoma.


METHODS
We report a case of a 57-year-old woman, who was initially examined because of polyarthritis, she was also diagnosed with type 2 diabetes mellitus and hypertension at age 56 years. Her history, clinical findings, laboratory results, and management are summarized, and etiologic hypotheses are discussed.


RESULTS
The patient had recurrent headaches and reported an increasing size of her shoes and gloves during the previous 4 years. Enlargement of her hands and feet and a bilateral temporal field defect were noted on examination. Laboratory studies revealed high levels of insulin-like growth factor I (IGF-I) and growth hormone (GH). Magnetic resonance imaging (MRI) showed a 3-cm sellar mass with impingement on the optic chiasm. The plasma level of growth hormone-releasing hormone (GHRH) was normal. She underwent transsphenoidal adenomectomy. Histologic examination confirmed a pituitary adenoma, immunoreactive for GH. Postoperatively, her headaches and arthritic pain diminished, and her levels of IGF-I and GH normalized; however, labile hypertension persisted. The urinary metanephrines and plasma catecholamines were increased. A 3-cm left adrenal mass, seen on abdominal MRI, was removed laparoscopically, after which urinary metanephrines normalized and both the diabetes and the hypertension resolved. Histopathologic analysis confirmed the diagnosis of pheochromocytoma. Immunohistochemical staining was negative for GHRH.


CONCLUSIONS
The finding of a pheochromocytoma and acromegaly could be a fortuitous coexistence of two separate endocrine tumors; however, the probability of such an event is extremely low. A cause-and-effect relationship has been suggested because of previous reports of GHRH production by pheochromocytomas. Some investigators have also suggested that this coexistence might be a multiple endocrine neoplasia variant. Our patient had no evidence of GHRH production, nor did we document any familial autosomal dominant transmission pattern.
Sleilati
Gina G
GG
Department of Endocrinology and Metabolism, Henry Ford Health System, Detroit, Michigan 48202, USA.
Kovacs
Kalman T
KT
Honasoge
Mahalakshmi
M
D000172:Acromegaly / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000236:Adenoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002395:Catecholamines / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy; D005260:Female; D013007:Growth Hormone-Releasing Hormone / Q000097:blood; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008676:Metanephrine / Q000652:urine; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
D002395:Catecholamines; D019382:Human Growth Hormone; D008676:Metanephrine; D007334:Insulin-Like Growth Factor I; D013007:Growth Hormone-Releasing Hormone