Abstract Clinical case A 58-year-old male patient referred to an endocrinologist due to elevated blood glucose levels. The examination revealed changes in his appearance. Laboratory FINDINGS: IGF-1 720 (89-255) ng/mL; GH 10.7 ng/mL; Glucose 8.09 mmol/L; HbA1c 7.4%. An MRI revealed a pituitary tumor 13x12x13 mm with infra-suprasellar and left-sided parasellar extension. Colonoscopy revealed a superficial epithelial neoplasm of the ascending colon, histological examination – a tubulovillous colon adenoma. Active acromegaly and diabetes mellitus as well as colon polyp were diagnosed. The recommended surgical treatment (pituitary adenomectomy, polypectomy) was not performed due to COVID-19. At the age of 60, the patient was re-examined: GH 21.1 ng/mL; IGF-1 582 ng/mL; Glucose 7.68 mmol/L; HbA1c 6.44%. The pituitary MRI was without changes. A colonoscopy revealed a malignant transformation of the neoplasm in the ascending colon. The decision was made to alter the treatment strategy and postpone neurosurgical treatment for acromegaly, initiating somatostatin analogs instead. The patient underwent a laparoscopic right hemicolectomy. Follow-up examinations at 3 and 6 months showed no signs of cancer recurrence. During the same period, control of acromegaly was not achieved (IGF-1 level 721 ng/mL). Transsphenoidal adenomectomy was performed, and 6 months later (patient age 61), the IGF-1 level was 258 ng/mL; Glucose 6.9 mmol/L; HbA1c 6.5%. Discussion. Over a long period (more than 5 years) with active acromegaly and elevated GH and IGF-1 levels, the patient showed no negative dynamics in the size of the somatotropinoma, and his type 2 diabetes mellitus and arterial hypertension did not progress (with ongoing medical treatment). However, the increase in size of the colonic lesion in the ascending colon was noted and dynamic histological examinations allowed for the detection of malignant transformation of the colonic epithelial lesion that timely changed treatment tactics. Conclusion This clinical case demonstrates the necessity of performing a full range of examinations (including colonoscopy) in a patient with active acromegaly and emphasizes the need for managing patients with acromegaly in multidisciplinary institutions.
Borovskaya et al. (Thu,) studied this question.