Balkany C, Cushing G W
Section of Endocrinology and Metabolism, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA.
Thyroid. 1995 Feb;5(1):47-50. doi: 10.1089/thy.1995.5.47.
Acromegaly has been associated with goiter as well as with benign and malignant tumors. Three cases of thyroid carcinoma in patients with acromegaly had been reported in the literature. We previously reported two additional cases of thyroid carcinoma and now present a third from 100 patients with acromegaly, exceeding the expected prevalence. All three thyroid carcinomas were multifocal, suggesting a generalized promotion toward malignancy. These patients had elevated levels of growth hormone and somatomedin-C [insulin-like growth factor (IGF-1)] at the time of thyroid carcinoma diagnosis. We discuss the role of IGF-1 in both benign and malignant thyroid growth, including the presence of IGF-1 receptors on thyroid cells, stimulation of thyroid cell replication by IGF-1, and paracrine secretion of IGF-1 and its binding proteins by thyroid cells. We propose possible mechanisms for the development of thyroid carcinoma in patients with acromegaly and discuss implications for the physician treating patients with acromegaly.
肢端肥大症与甲状腺肿以及良性和恶性肿瘤有关。文献中曾报道过3例肢端肥大症患者患甲状腺癌的病例。我们之前报告过另外2例甲状腺癌病例，现在又从100例肢端肥大症患者中报告了第3例，其发病率超过预期。所有3例甲状腺癌均为多灶性，提示存在向恶性肿瘤发展的普遍倾向。这些患者在甲状腺癌诊断时生长激素和生长调节素C（胰岛素样生长因子-1）水平升高。我们讨论了胰岛素样生长因子-1在甲状腺良性和恶性生长中的作用，包括甲状腺细胞上胰岛素样生长因子-1受体的存在、胰岛素样生长因子-1对甲状腺细胞复制的刺激，以及甲状腺细胞旁分泌胰岛素样生长因子-1及其结合蛋白的情况。我们提出了肢端肥大症患者发生甲状腺癌的可能机制，并讨论了对治疗肢端肥大症患者的医生的启示。
