title: Polycythemia as rare secondary direct manifestation of acromegaly: management and single-centre epidemiological data.
abstract: Polycythemia associated with acromegaly is usually caused by the systemic manifestations of the disease, such as sleep-apnea or concomitant erythropoietin-secreting kidney tumors. The recognition of underlying pathologies requires a thorough diagnostic process. We report a unique case of acromegaly with polycythemia, not caused by commonly described manifestations of the disease, and receding with octreotide therapy. The medical history of 141 acromegalic patients followed by the Endocrinology Unit of the San Martino University Hospital in Genoa has been also reviewed, together with the literature evidence for similar cases. The diagnostic workflow and 2-years follow-up of a 43-years old acromegalic, polycythemic man with a history of past smoking, moderate hypertension, and mental retardation are described. The hematological parameters of our cohort was retrospectively compared with those of a healthy, age/gender-related control group as well. Therapy with octreotide LAR, 20 mg i.m. q28d was begun soon after diagnosis of acromegaly in the polycythemic patient. Haematocrit level, hormonal setting, as well as pituitary tumor size and visual perimetry during treatment were recorded. Octreotide LAR treatment normalized hormonal alterations, as well as hematological parameters. Polycythemia has not recurred after 2 years of therapy. The median hemoglobin and hematocrit levels of the retrospectively analyzed cohort of acromegalic were significantly lower than normal ranges of a healthy, age/sex- related control population. In conclusions, polycythemia can be a direct, albeit rare, secondary manifestation of acromegaly, that must be considered during the diagnostic work-up of acromegalic patients presenting with such disorder.
authors.affiliation: Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Zoppoli
authors.forename: Federico
authors.initials: F
authors.lastname: Bianchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Bruzzone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Calvia
authors.forename: Caterina
authors.initials: C
authors.lastname: Oneto
authors.forename: Caterina
authors.initials: C
authors.lastname: Passalia
authors.forename: Enrico
authors.initials: E
authors.lastname: Balleari
authors.forename: Davide
authors.initials: D
authors.lastname: Bedognetti
authors.forename: Elena
authors.initials: E
authors.lastname: Ponomareva
authors.forename: Elena
authors.initials: E
authors.lastname: Nazzari
authors.forename: Lara
authors.initials: L
authors.lastname: Castelletti
authors.forename: Lucio
authors.initials: L
authors.lastname: Castellan
authors.forename: Francesco
authors.initials: F
authors.lastname: Minuto
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ghio
authors.forename: Diego
authors.initials: D
authors.lastname: Ferone
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D000328:Adult; D000368:Aged; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D011086:Polycythemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide