Chen Yu-Chen, Chen Hao-Wei, Chen Ming-Tan, Huang Chun-Hsiung, Li Ching-Chia, Juan Yung-Shun, Ke Hung-Lung
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan.
Low Urin Tract Symptoms. 2019 Apr;11(2):O218-O220. doi: 10.1111/luts.12216. Epub 2018 Feb 5.
Acromegaly is a rare disease associated with an increased risk of prostate enlargement. Severe prostate enlargement with severe lower urinary tract symptoms (LUTS) in an acromegalic patient is even more uncommon. Herein we report on a 55-year-old man who was diagnosed with acromegaly and prostate enlargement at 40 years of age. Transsphenoidal surgery, postoperative radiotherapy, and octreotide medical therapy failed to control the acromegaly, and growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels remained elevated. When the patient was 53 years of age, severe LUTS and prostate enlargement (prostate volume = 128 mL) were noted. However, LUTS improved and prostate volume decreased markedly after 5α-reductase inhibitors were used, despite the poorly controlled acromegaly (elevated GH and IGF-1 levels). This is the first long-term observation of LUTS and prostate enlargement in a poorly controlled acromegalic patient. Although the GH-IGF-1 axis was a factor contributing to prostate enlargement, the present case suggests that androgens may still play an essential role in prostate enlargement and symptoms in active acromegalic patients >50 years of age. Indeed, we should be aware that suppressing the GH-IGF-1 axis is not the only treatment choice for prostate enlargement in acromegalic patients, and even in poorly controlled acromegalic patients in whom suppression of the GH-IGF-1 axis is difficult. Symptomatic prostate enlargement in cases of active acromegaly can be treated with 5α-reductase inhibitors, as in general benign prostate hyperplasia populations.
肢端肥大症是一种罕见疾病，与前列腺增生风险增加相关。肢端肥大症患者出现严重前列腺增生并伴有严重下尿路症状（LUTS）的情况更为罕见。在此，我们报告一名55岁男性，他在40岁时被诊断为肢端肥大症和前列腺增生。经蝶窦手术、术后放疗及奥曲肽药物治疗均未能控制肢端肥大症，生长激素（GH）和胰岛素样生长因子1（IGF-1）水平仍居高不下。患者53岁时，出现严重LUTS及前列腺增生（前列腺体积 = 128 mL）。然而，尽管肢端肥大症控制不佳（GH和IGF-1水平升高），但使用5α还原酶抑制剂后，LUTS有所改善，前列腺体积明显减小。这是对一名肢端肥大症控制不佳患者的LUTS和前列腺增生的首次长期观察。虽然GH-IGF-1轴是导致前列腺增生的一个因素，但本病例表明，雄激素在50岁以上活跃的肢端肥大症患者的前列腺增生和症状中可能仍起重要作用。事实上，我们应该意识到，抑制GH-IGF-1轴并非肢端肥大症患者前列腺增生的唯一治疗选择，即使是在难以抑制GH-IGF-1轴的肢端肥大症控制不佳患者中也是如此。对于活跃的肢端肥大症患者出现的有症状的前列腺增生，可像一般良性前列腺增生人群一样，用5α还原酶抑制剂进行治疗。
