Renaissance of acromegaly after bariatric surgery

Abstract

Dear Sir,The discouraging results provided by dietary andbehavioural treatments, and the virtually non-existent drugtreatments, have led to an exponential increase in use ofsurgery to treat obesity [1]. An increased prevalence ofobesity has also been reported in patients with acromegaly,a rare and severe systemic disease caused by a growthhormone (GH)-secreting pituitary adenoma, compared tothe general population [2]. In obesity, GH responses to awide variety of GH secretion stimulators, as well as 24 hspontaneous GH release are decreased, making difficultacromegaly follow-up. Moreover, insulin-like growth fac-tor-1 (IGF-1), which mediates some of the metabolicactions of GH, is reported to be decreased in obesity andnegatively correlated to visceral fat [3]. To the best of ourknowledge, we report the first case of a patient withacromegaly who underwent bariatric surgery and wedescribe the biochemical effects associated with the reso-lution of obesity and its comorbidities.A 55-year-old Caucasian woman with acromegaly wasreferred to our Obesity Unit in January 2006. Her historyincluded a long condition of morbid obesity since child-hood, with gradual increase of weight from her secondpregnancy, holding a weight in recent years around 115 kg.She had undergone a selective trans-sphenoidal removal ofa pituitary adenoma of 2.3 cm with suprasellar extension,impingement of the optic chiasm, and invasion of the leftcavernous sinus at age 35. Postoperatively, she was undertreatment first with bromocriptine and after with somatos-tatine-analogues at stable doses (lanreotide 90 mg oncemonthly). However, her serum IGF-1 values remainedabove the adjusted normal range.Her medical history revealed type 2 diabetes (T2D)treated with metformin and insulin without achievingadequate metabolic control, hypertension started onangiotensin-converting enzyme inhibitors with normaliza-tion of blood pressure, and sleep apnoea syndrome (SAS)requiring nasal continuous positive airway pressure(nCPAP) mask. In addition, the patient had been treated fordegenerative arthritis of the knees, and bilateral carpaltunnel compression syndrome had been surgically resolvedfew years before. The familial medical history was other-wise unremarkable.Clinical examination showed a female patient withtypical clinical signs of acromegaly, including coarse facialfeatures and enlargement of her hands and feet. Her weight,height and body mass index (BMI) were 106.3 kg, 142.0 cmand 52.5 kg/m