Di Cerbo Alfredo, Pezzuto Federica, Di Cerbo Alessandro
Endocrinology, 'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, FoggiaItaly.
Department of Medical, Oral and Biotechnological Sciences, Dental School, University 'G. d'Annunzio' of Chieti-Pescara, ChietiItaly.
Endocrinol Diabetes Metab Case Rep. 2017 Jun 7;2017. doi: 10.1530/EDM-17-0061. eCollection 2017.
Graves' disease, the most common form of hyperthyroidism in iodine-replete countries, is associated with the presence of immunoglobulins G (IgGs) that are responsible for thyroid growth and hyperfunction. In this article, we report the unusual case of a patient with acromegaly and a severe form of Graves' disease. Here, we address the issue concerning the role of growth hormone (GH) and insulin-like growth factor 1 (IGF1) in influencing thyroid function. Severity of Graves' disease is exacerbated by coexistent acromegaly and both activity indexes and symptoms and signs of Graves' disease improve after the surgical remission of acromegaly. We also discuss by which signaling pathways GH and IGF1 may play an integrating role in regulating the function of the immune system in Graves' disease and synergize the stimulatory activity of Graves' IgGs.
Clinical observations have demonstrated an increased prevalence of euthyroid and hyperthyroid goiters in patients with acromegaly.The coexistence of acromegaly and Graves' disease is a very unusual event, the prevalence being <1%.Previous studies have showed that IGF1 synergizes the TSH-induced thyroid cell growth-activating pathways independent of TSH/cAMP/PKA cascade.We report the first case of a severe form of Graves' disease associated with acromegaly and show that surgical remission of acromegaly leads to a better control of symptoms of Graves' disease.
在碘充足国家，格雷夫斯病是甲状腺功能亢进最常见的形式，与导致甲状腺生长和功能亢进的免疫球蛋白G（IgG）的存在有关。在本文中，我们报告了一例肢端肥大症合并严重格雷夫斯病的罕见病例。在此，我们探讨生长激素（GH）和胰岛素样生长因子1（IGF1）在影响甲状腺功能方面的作用问题。肢端肥大症并存会加重格雷夫斯病的严重程度，肢端肥大症手术缓解后，格雷夫斯病的活动指标以及症状和体征均有所改善。我们还讨论了GH和IGF1可能通过哪些信号通路在调节格雷夫斯病免疫系统功能中发挥整合作用，并协同格雷夫斯病IgG的刺激活性。
临床观察表明，肢端肥大症患者中甲状腺功能正常和亢进性甲状腺肿的患病率增加。肢端肥大症和格雷夫斯病并存是非常罕见的情况，患病率<1%。先前的研究表明，IGF1可协同促甲状腺激素（TSH）诱导的甲状腺细胞生长激活途径，独立于TSH/环磷酸腺苷（cAMP）/蛋白激酶A（PKA）级联反应。我们报告了首例与肢端肥大症相关的严重格雷夫斯病病例，并表明肢端肥大症手术缓解可更好地控制格雷夫斯病症状。
