RESUMO
Ectopic acromegaly represents less than 1% of the reported cases of acromegaly. Although clinical improvement is common after treatment with somatostatin (SMS) analogs, the biochemical response and tumor size of the growth hormone-releasing hormone (GHRH)-producing tumor and its metastases are less predictable. Subject A 36-year-old male was referred because of a 3-year history of acromegaly related symptoms. He had undergone lung surgery in 1987 for a "benign" carcinoid tumor. Endocrine evaluation confirmed acromegaly Plasma IGF-1: 984 ng/ml (63-380), GH: 49.8 ng/ml (<5). MRI showed a large mass in the left cerebellopontine angle and diffuse pituitary hyperplasia. Pulmonary, liver and bone metastases were shown by chest and abdominal CT scans. Ectopic GHRH secretion was suspected. Methods Measurement of circulating GHRH levels by fluorescence immunoassay levels and immunohistochemical study of the primary lung tumor and metastatic tissue with anti-GHRH and anti-somatostatin receptor type 2 (sst2A) antibodies. Results Basal plasma GHRH: 4654 pg/ml (<100). Pathological study of liver and bone biopsy material and lung tissue removed 19 years earlier was consistent with an atypical carcinoid producing GHRH and exhibiting sst2A receptor expression. Treatment with octreotide LAR 20-40 mg q. month resulted in normalization of plasma IGF-1 levels. Circulating GHRH levels decreased dramatically. The size of the left prepontine cistern mass, with SMS receptors shown by a radiolabeled pentetreotide scan, decreased by 80% after 18 months of therapy. Total regression of pituitary enlargement was also observed. No changes were observed in lung and liver metastases. After 24 months of therapy the patient is asymptomatic and living a full and active life.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias Brônquicas/metabolismo , Neoplasias Brônquicas/secundário , Tumor Carcinoide/metabolismo , Tumor Carcinoide/secundário , Hormônio Liberador de Hormônio do Crescimento/metabolismo , Hormônios Ectópicos/metabolismo , Hormônio do Crescimento Humano/metabolismo , Octreotida/uso terapêutico , Acromegalia/etiologia , Adulto , Glicemia/metabolismo , Neoplasias Brônquicas/tratamento farmacológico , Tumor Carcinoide/tratamento farmacológico , Ângulo Cerebelopontino/patologia , Humanos , Fígado/patologia , Imageamento por Ressonância Magnética , Masculino , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Receptores de Somatostatina/metabolismo , Imagem Corporal TotalAssuntos
Tecido Adiposo/metabolismo , Doenças Cardiovasculares/etiologia , Peptídeos e Proteínas de Sinalização Intercelular , Sistema Renina-Angiotensina , Fator D do Complemento , Hormônios Ectópicos/metabolismo , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/metabolismo , Hipertensão/etiologia , Leptina/metabolismo , Obesidade/complicações , Obesidade/metabolismo , Resistina , Serina Endopeptidases/metabolismo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Young male golden hamsters, made hyperprolactinemic by a pituitary graft under the kidney capsule, were exposed to a light pulse (1,000 lx/30 min) at Zeitgeber time (ZT) 18. Controls included hamsters receiving a sham graft (muscle). Fos immunoreactive cells were counted in both suprachiasmatic nuclei (SCN) of each animal, using an image analyzer system. The Fos immunoreactivity (Fos-ir) of the ventrolateral and dorsomedial SCN regions was greater in the pituitary-grafted hamsters. Indeed, light induced the greatest response in grafted animals in both SCN regions. However, the SCN of pituitary-grafted hamsters in the absence of light showed the lowest Fos-ir in both regions. The results support the occurrence of a dual effect of hyperprolactinemia on Fos-ir in the SCN of hamsters at ZT 18, with inhibition of Fos expression in the absence of light and potentiation of early gene expression when animals were exposed to a light pulse.