Multidisciplinary approachto management of a patient with acromegaly and colon cancer (a clinical case)

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Acromegaly is a disease that occurs due to prolonged, uncontrolled hypersecretion of growth hormone by a pituitary tumor. Acromegaly is a significant risk factor for colon cancer. A clinical case of colon adenocarcinoma diagnosed in a patient with active acromegaly is presented.The aim was to demonstrate a multidisciplinary approach to the treatment of a patient with acromegaly when diagnosed with cancer. Clinical case. Active acromegaly due to pituitary macroadenoma (somatotropinoma) and associated type 2 diabetes mellitus were diagnosed in the 56-year-old patient. The additional examination (including colonoscopy) and transsphenoidal adenomectomy as the first-line acromegaly treatment were recommended but not performed due to restrictive measures during the pandemic (COVID-19), he was taking metformin. At age 58, a repeat examination revealed no negative dynamics in the somatotropinoma size without treatment, nevertheless, IGF-1 and HbA1c levels worsened. Colonoscopy revealed tubulovillous adenoma of the ascending colon. Treatment of diabetes mellitus was optimized, neurosurgy for acromegaly as well as polypectomy were recommended. From the set of prescriptions and recommendations, However, the patient followed the treatment of diabetes mellitus only. At age 60, after repeated colonoscopy and histological examination the malignant neoplasm of the ascending colon was diagnosed in our patient that required the primary diagnosis changing and corresponding changing in treatment tactics. Prolonged-acting somatostatin analogs were prescribed, laparoscopic right-sided hemicolectomy with subsequent active monitoring was performed. Control examinations after 3 and 6 months showed no convincing signs of cancer recurrence. Successful transnasal transsphenoidal adenomectomy was finally performed. Management of patients with acromegaly requires a multidisciplinary approach and a combination of clinical guidelines depending on the individual spectrum of concomitant comorbid diseases.

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