title: Acromegaly in a patient with a pulmonary neuroendocrine tumor: case report and review of current literature.
abstract: BACKGROUND
  Pulmonary neuroendocrine tumors (NET) form a heterogeneous group of rare diseases. In these tumors, paraneoplastic syndromes have been described to drive the course of the disease, among them acromegaly induced by paraneoplastic secretion of growth hormone-releasing hormone (GHRH).
  
  
  METHODS
  We report the case of a 43 years old patient initially diagnosed with acromegaly accompanied by weight gain and acral enlargement. Subsequently, further diagnostic work-up identified a solitary pulmonary neuroendocrine tumor (NET). Laboratory tests revealed markedly increased growth hormone (GH) and insulin-like growth factor 1 (IGF-1) without GHRH elevation in the absence of pituitary pathologies confirming the paraneoplastic origin of clinical presentation with acromegaly. Curative surgery was performed leading to normalization of the elevated hormone levels and improvement of the clinical symptoms. Immunohistochemically, a typical carcinoid (TC) was seen with low proliferation index and abundant IGF-1 expression.
  
  
  CONCLUSIONS
  The association of acromegaly and pulmonary NET has only rarely been reported. We present an individual case of paraneoplastic GH- and IGF-1 secretion in a patient with pulmonary NET. Based on their rarity, the knowledge of paraneoplastic syndromes occurring in patients with pulmonary NET such as acromegaly due to paraneoplastic GH- and IGF-1 secretion is mandatory to adequately diagnose and treat these patients.
authors.affiliation: Department of Gastroenterology, Endocrinology and Metabolism, Philipps-University Marburg, Marburg, Germany.|Department of Gastroenterology and Hepatology, Martin-Luther University Halle/Wittenberg, Ernst-Grube Straße 40, 06120, Halle (Saale), Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Krug
authors.affiliation: Department of Gastroenterology, Endocrinology and Metabolism, Philipps-University Marburg, Marburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Boch
authors.affiliation: Institute of Pathology, Philipps-University Marburg, Marburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rexin
authors.affiliation: Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pfestroff
authors.affiliation: Department of Gastroenterology, Endocrinology and Metabolism, Philipps-University Marburg, Marburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gress
authors.affiliation: Department of Gastroenterology and Hepatology, Martin-Luther University Halle/Wittenberg, Ernst-Grube Straße 40, 06120, Halle (Saale), Germany. patrick.michl@uk-halle.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Michl
authors.affiliation: Department of Gastroenterology, Endocrinology and Metabolism, Philipps-University Marburg, Marburg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Rinke
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism; D000328:Adult; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000378:metabolism; D019394:Ki-67 Antigen / Q000032:analysis; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D018358:Neuroendocrine Tumors / Q000150:complications / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography
chemical_list: D019394:Ki-67 Antigen; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I
keywords: Acromegaly; GH; IGF-1; Paraneoplastic syndromes; Pulmonary neuroendocrine tumor