March/April - West Virginia State Medical Association

| Scientific ArticleTable 3. When to suspect GHRH dependent acromegaly?Indications for measurement of GHRH levels in acromegaly1.2.3.4.5.Known case of multiple endocrine neoplasia (MEN-1)Family history of multiple endocrine neoplasia (MEN-1)Presence of known neuroendocrine tumor (NECT)Co-existence of hyperprolactinemia and acromegalyAbsence of classic pituitary adenoma in MRI (either normal orhyperplastic pituitary gland)and IGF-I levels after removal ofthe tumor to near normal. 11,12 Ourcase met almost all these criteria.Neuroimaging studies of thehypothalamic pituitary gland inectopic GHRH induced acromegalyhave provided variable results, fromno tumor to slight enlargementor well defined pituitary mass. 9Histopathology specimens ofPituitary glands from GHRHinduced acromegaly have showna continuum of hyperplasia toadenoma and adenomatoustransformation can be found ona background of hyperplasia. 9As MEN-1 patients can haveboth pituitary tumors and NECT,it seems reasonable to screen allMEN-1 patients with acromegaly forectopic GHRH induced acromegaly(Table 3). Serum GHRH levels canbe used as an initial screening test.Previously reported GHRHsecreting NECT were usually largeenough to be seen on CT scan ofabdomen and chest respectively.Octreotide scintigraphy can beuseful in detecting the tumors thathave rich somatostatin receptors 9,13,14but the test is not definitive.Surgical removal of the GHRHproducing tumor is the therapyof choice for ectopic GHRHinduced acromegaly. 9 In case of aninoperable tumor, high surgicalrisk or unsuccessful surgery, GHhypersecretion can be controlledeither by pituitary surgery or pituitaryradiation. Another alternative ismedical treatment. Dopamine agonisttherapy has variable effect on GHand IGF1 levels but doesn’t affectGHRH levels or tumor size. 9 Longacting somatostatin analog octreotidecan inhibit GHRH secretion fromNECT as well as GH secretion fromanterior pituitary gland directly. Itcan reduce GH and IGF1 levels atrelatively lower doses, but higherdoses are required for suppressionof GHRH levels, shrinkage of theprimary tumor and reduction of9, 13,14secondary pituitary enlargement.Want More Than a Boxfrom your EMR software?With Physician’s Business Office and Centricity ®EMR by GE Healthcare, you get state-of-the-artsoftware and an experienced support team workingwith you every step of the way.Give us a call to see how we can help you get tothe next level in patient care.Electronic Medical Records • Practice Management3211 Dudley Avenue, Parkersburg, WV 26104Call Jill Redinger (304) 482-8045 or Jeff Matheny (304) 422-0578web: physiciansbusinessoffice.com • e-mail: jill@pbo.bzMarch/April 2012 | Vol. 108 29