Leporati Paola, Fonte Rodolfo, de Martinis Luca, Zambelli Alberto, Magri Flavia, Pavesi Lorenzo, Rotondi Mario, Chiovato Luca
Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri I.R.C.C.S., Laboratory for Endocrine Disruptors, Chair of Endocrinology, University of Pavia, 27100, Pavia, Italy.
Unit of Medical Oncology, Fondazione Salvatore Maugeri I.R.C.C.S., 27100, Pavia, Italy.
BMC Cancer. 2015 May 12;15:397. doi: 10.1186/s12885-015-1400-0.
Acromegaly is a rare disease associated with an increased risk of developing cancer.
We report the case of a 72-year-old man who was diagnosed with acromegaly (IGF-1 770 ng/ml) and breast cancer. Four years before he suffered from a colon-rectal cancer. Pituitary surgery and octreotide-LAR treatment failed to control acromegaly. Normalization of IGF-1 (97 ng/ml) was obtained with pegvisomant therapy. Four years after breast cancer surgery, 2 pulmonary metastases were detected at chest CT. The patient was started on anastrozole, but, contrary to medical advice, he stopped pegvisomant treatment (IGF-I 453 ng/ml). Four months later, chest CT revealed an increase in size of the metastatic lesion of the left lung. The patient was shifted from anastrozole to tamoxifen and was restarted on pegvisomant, with normalization of serum IGF-1 levels (90 ng/ml). Four months later, a reduction in size of the metastatic lesion of the left lung was detected by CT. Subsequent CT scans throughout a 24-month follow-up showed a further reduction in size and then a stabilization of the metastasis.
This is the first report of a male patient with acromegaly and breast cancer. The clinical course of breast cancer was closely related to the metabolic control of acromegaly. The rapid progression of metastatic lesion was temporally related to stopping pegvisomant treatment and paralleled a rise in serum IGF-1 levels. Normalization of IGF-1 after re-starting pegvisomant impressively reduced the progression of metastatic breast lesions. Control of acromegaly is mandatory in acromegalic patients with cancer.
肢端肥大症是一种罕见疾病，患癌风险增加。
我们报告一例72岁男性患者，诊断为肢端肥大症（胰岛素样生长因子-1[IGF-1] 770 ng/ml）并患有乳腺癌。四年前他曾患结肠直肠癌。垂体手术和奥曲肽长效释放制剂治疗未能控制肢端肥大症。使用培维索孟治疗后IGF-1恢复正常（97 ng/ml）。乳腺癌手术后四年，胸部CT检测到2处肺转移。患者开始使用阿那曲唑治疗，但他不听医嘱，停止了培维索孟治疗（IGF-Ⅰ 453 ng/ml）。四个月后，胸部CT显示左肺转移病灶增大。患者从阿那曲唑改用他莫昔芬，并重新开始使用培维索孟，血清IGF-1水平恢复正常（90 ng/ml）。四个月后，CT检测到左肺转移病灶缩小。在随后24个月的随访中，后续的CT扫描显示转移灶进一步缩小，然后趋于稳定。
这是首例关于肢端肥大症男性患者并发乳腺癌的报告。乳腺癌的临床病程与肢端肥大症的代谢控制密切相关。转移病灶的快速进展在时间上与停止培维索孟治疗相关，并与血清IGF-1水平升高平行。重新开始使用培维索孟后IGF-1恢复正常显著降低了转移性乳腺病灶的进展。对于患有癌症的肢端肥大症患者，控制肢端肥大症是必需的。
