title: Acromegaly Presenting With Bilateral Vocal Fold Immobility: Case Report and Review of the Literature.
abstract: OBJECTIVE
  To present a case of bilateral vocal fold immobility (BVCI) in a patient with acromegaly and review the current literature describing this presentation.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  English language literature search of online journal databases.
  
  
  RESULTS
  A 56-year-old man presented with 3 months of progressive stridor and shortness of breath. Transnasal flexible endoscopy revealed BVCI. A tracheostomy was performed to secure his airway. Further history was suggestive of acromegaly and imaging demonstrated a pituitary macroadenoma. The diagnosis of acromegaly was made. The patient was treated with octreotide followed by an endoscopic trans sphenoidal resection of the pituitary adenoma. Sixteen months after his initial presentation, a right laser arytenoidectomy was performed and the patient was subsequently decannulated. In the literature to date, 11 cases of BVCI in acromegaly have been reported. These patients often present with stridor and require a tracheostomy. With treatment of their acromegaly, these patients may regain vocal fold mobility and may be decannulated.
  
  
  CONCLUSIONS
  Acromegaly with BVCI is a rare presentation. Acute management of the airway of patients with acromegaly presenting with BVCI typically requires a tracheostomy. A period of 15 months should be allowed for restoration of vocal fold mobility before airway opening procedures are considered.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
authors.forename: Timothy
authors.initials: T
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dziegielewski
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
authors.forename: Praby
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.. Electronic address: r_see_00@yahoo.ca.
authors.forename: Robert
authors.initials: R
authors.lastname: Seemann
mesh_terms: D000172:Acromegaly / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000236:Adenoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015282:Octreotide / Q000627:therapeutic use; D020127:Recovery of Function; D012135:Respiratory Sounds; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014827:Vocal Cords / Q000503:physiopathology*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide
keywords: Acromegaly; Airway; Stridor; Vocal fold fixation; Vocal fold immobility