Aşkın GÜNGÜNEŞ, Nesrin TURHAN, Dilek OĞUZ, Aydın ÇİFCİ, Selim YALÇIN, Şenay DURMAZ ARIKAN

Akromegali ve pankreas adenokarsinomunun insidental birlikteliği olan nadir bir vaka: olgu sunumu

Akromegali nadir bir endokrin hastalıktır. Akromegali, premalign tübüler adenom ve kolorektal kanser stiroid gibi ı Elli iki ya ında erkek hasta, yakla ık 2 yıl önce akromegali tanısı aldı. Tanı sonrası transsfenoidal cerrahi uygulandı. Cerrahi sonrası büyüme hormonu ve insülin benzeri büyüme faktörü (IGF-1) düzeyleri normale dönmeyen hastaya bu nedenle somatostatinanalog tedavisi ba landı. Bu tedaviyi takiben IGF-1değeri yaş ve cinsiyete göre normale döndü. Aynı hasta ay önce karın ağrısı şikayeti ile polikliniğimize başvurdu.Abdomen bilgisayarh tomografide pankreas kuyruk kesiminde 44x26 mm boyutlarında kitle lezyonu ve karaciğerde çok sayıda metastatiklezyon saptandı. Üst gastrointestinalsistem endoskopisi ve kolonoskopide sırasıyla eroziv gastrit ve kolonda polipler gözlendi. Pankreas kuy--ruğundaki kitle lezyonundan endoskopik ultrasonografi eşliğinde ince iğne aspirasyon biyopsisi yapıldı. Patolojik inceleme pankreas kaynaklıduktal adenokarsinom ile uyumlu id.Akromegalisi olan hastalarda benign ve malign neoplazm riskinde artış olup bu durum dolaşımdaki artmış IGF-l düzeyleri ile ilişkili olabilir.IGF-l, proliferatif ve anti-apoptotik etkinliğe sahiptir. Akromegali ve metastatik pankreatik tümör birlikteliği literatürde yer almakla birlikte 01-dukça nadirdir Akromegali hastalarında pankreas adenokasinomu ve diğer malign hastalıklann olabileceğini dikkate almak gerekir.

A rare case with incidental coexistence of acromegaly and pancreatic adenocarcinoma: case report

Acromegaly is rare endocrine disease. Acromegaly is associated with an increased prevalence of colorectal cancer and pre--malignant tubularadenomas, and also may be associated with other organ malignancies such as breast and thyroid. In this article, we reported rare case in the lightof coexistence of acromegaly and incidental pancreatic adenocarcinoma.52-year--old man who was diagnosed with acromegaly about two years ago. After diagnosis, transsphenoidal surgery was performed. Aftersurgery serum growth hormone (GH) and insulin-like growth factor (IGF-l) levels was not return to normal, therefore somatostatin analogtreatment was started. After this treatment, serum IGF-l concentration was normal for age and gender. He was admitted to out-patient clinic withabdominal pain month ago. 44x26 mm mass lesion in the tail of the pancreas and multiple metastatic lesions in the liver were detected on abdomencomputed tomography (CT). Erosive gastritis and polyps in the colon were observed on upper gastrointestinal endoscopy and oolonoscopy,respectively. Endoscopic ultrasound-guided fine needle aspiration biopsy was performed to the mass lesions in the tail of the pancreas. Patholo--gical examination was consistent with ductal adenocarcinoma arising from the pancreas.The patients with acromegaly have an increased risk of benign and malignant neoplasms, these situation may be related with increased circulatinglevels of IGF-1. IGF--l have proliferative and anti--apoptotic activity. The coexistence of acromegaly and metastatic pancreatic tumor waspresent in the literature but it is quite rare. It is necessary to consider that pancreatic adenocarcinoma and other malignant diseases may presentin acromegaly patients.

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