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A complex case of Multiple Endocrine Neoplasia type 1 with Metastatic Parathyroid Carcinoma

100%
Kalavalapalli S., Talapatra I., Connell I.
Open Medicine
|
2010
|
vol. 5
|
issue 1
53-58
EN
We describe below a patient with Multiple Endocrine Neoplasia type 1 (MEN type 1) who presented with features of Primary Hyperparathyroidism. However, the actual diagnosis of Parathyroid Carcinoma was delayed until metastases to the lung were discovered. She was also found to have Pituitary Macro adenoma with Silent Acromegaly, with no clinical features whatsoever. She underwent transphenoidal hypophysectomy with postoperative radiotherapy. However, the disease process remained biochemically active necessitating commencement of somatostatin analogues. There is also a tumour at the head of the pancreas which at present is non functional with normal gut hormone profile and normal 24 hour urinary 5-hydroxyl indole acetic acid (5-HIAA) excretion assay. Our case highlights the pitfalls in diagnosing the parathyroid carcinoma due to lack of initial proper histological features. The diagnosis of parathyroid carcinoma was based on histologically confirmed metastases to the lungs. We also discuss below the entity called Silent Acromegaly where patients have biochemically and/or histologically confirmed growth Hormone (GH) excess with no clinical features suggesting Acromegaly. We discuss the benefits of somatostatin analogues in indirectly controlling the rest of the tumours in MEN1 and hypothesise the same for metastatic parathyroid carcinoma. Metastatic parathyroid carcinoma with multiple endocrine neoplasia type 1 is extremely rare. Our case highlights the complexities of managing MEN1 with metastatic parathyroid carcinoma and the dilemmas in dealing with the various aspects of the care.
2
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Prevalence and recurrence rate of colonic lesions in acromegalic patients

88%
Berker D., Tutuncu Y., Isik S., Aydin Y., Ozuguz U., Akbaba G., Yuksel O., Erden G., Altiparmak E., Guler S.
Open Medicine
|
2010
|
vol. 5
|
issue 6
704-711
EN
Acromegaly is associated with an increased prevalence of colonic polyps. The aim of this study was to evaluate the prevalence and recurrence rate of colonic polyps in acromegalic patients. Ninety-six acromegalic patients and 100 irritable bowel syndrome patients (IBS) were enrolled in the study. Twenty patients who were cured exclusively by surgery, and 20 patients that could not be hormonally controlled were re-examined colonoscopically after 36 months. Twenty-nine of 96 acromegalic patients (30.2%) had colonic polyps. In the IBS group, 10 (10.0%) had colonic polyps. The prevalence of colonic polyps was significantly higher in acromegaly. The group of acromegalic patients with and without polyps did not differ significantly with regard to plasma GH, IGF-I, fasting insulin levels and glycemic status. The presence of colonic polyps was correlated with increased patient age and male gender. We did not observe a difference in terms of polyp recurrence frequencies in the patients cured by surgery compared to uncontrolled patients. Acromegalic patients have a higher prevalence of colonic polyps than that of control subjects. We could not identify any factors that could predict polyps within the acromegalic patients - but age and male sex.
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