Endocrinol Metab.  2015 Mar;30(1):110-115. 10.3803/EnM.2015.30.1.110.

Multiple Myeloma in a Patient with Acromegaly

• Kang YM
• Choi JH
• Lee MJ
• Ahn A
• Park CJ
• Chang K
• Seo S
• Hong SI
• Kim MS

• KMID: 2407113
• DOI: http://doi.org/10.3803/EnM.2015.30.1.110

Abstract

Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.

Keyword

Acromegaly; Multiple myeloma; Insulin-like growth factor I

MeSH Terms

Acromegaly*
Anemia
Apoptosis
Asia
Bone Marrow Examination
Cell Proliferation
Consensus
Female
Growth Hormone
Growth Hormone-Secreting Pituitary Adenoma
Humans
Insulin-Like Growth Factor I
Middle Aged
Mortality
Multiple Myeloma*
Neoplasms, Plasma Cell
Pituitary Neoplasms
Prognosis
Growth Hormone
Insulin-Like Growth Factor I

Figure

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  Fig. 1 (A) Physical examination of the patient revealed frontal bossing, thickened lips, and an enlarged nose. (B) Exaggerated frontal bossing (arrow) observed from the side. Disproportionately enlarged (acromegalic) hands (C) and feet (D) were also seen.

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  Fig. 2 A T1-weighted coronal magnetic resonance imaging of the sella turcica indicated a 10×6-mm hypointense, nonenhanced pituitary adenoma on the left side of the pituitary gland (arrow).

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  Fig. 3 Peripheral blood smear results revealed a red blood cell rouleaux formation (arrow; Wright stain, ×1,000).

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  Fig. 4 (A) Neoplastic plasma cells in the bone marrow aspirate specimen (Wright stain, ×1,000). (B) Numerous clustered neoplastic plasma cells on a bone marrow touchprint slide. (C) Packed neoplastic plasma cells were prominent in a bone marrow biopsy specimen stained with H&E (×400). (D) CD138-positive neoplastic plasma cells in an immunohistochemically stained bone marrow biopsy specimen (×400). In an immunohistochemically stained bone marrow biopsy specimen, neoplastic cells were positive for λ light chain (E, ×400) and negative for κ light chain (F, ×400).

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