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Internal Medicine

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Internal Medicine

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Internal Medicine

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Internal Medicine

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Clinical Science

Abstract

Background: Acromegaly is a growth disorder characterized by overproduction of growth hormone and IGF-1. Such overproduction of growth factors has been linked to several types of malignancy, most commonly, thyroid, colorectal, and breast neoplasms. While research does favor the increased incidence of cancer in acromegaly patients, the association with malignant melanoma is not well understood. With present a unique case of metastatic melanoma in a patient with acromegaly, as such cases are exceedingly rare in the literature.

Case presentation: A 41-year-old male with a past medical history of acromegaly, status post pituitary tumor resection, presented to the emergency department with severe back pain and right lower extremity weakness for one month. On physical examination the patient had characteristic features of acromegaly including tall body habitus, large hands, and scoliosis of the spine. He displayed decreased strength in the right lower extremity and decreased sensation at the level of T9. An MRI of the thoracic spine revealed enhancing vertebral lesions of T6 and T7, and extradural mass causing severe cord compression on the right side. Further imaging revealed right-sided lung, and liver lesions as well as leptomeningeal metastases in the left cerebral hemisphere. Patient was seen by Neurosurgery and underwent debulking surgery of the tumor in his spine. Biopsies taken from one of the metastatic lung lesions, and from the spinal cord tumor revealed metastatic melanoma on histopathology. The patient remained hospitalized while undergoing physical rehabilitation with plans to begin oncological treatment upon discharge.

Conclusions: Patients with acromegaly are at high risk for complications, and recent research studies have shown that malignancy; thyroid and colon cancer is the number one cause of mortality in this population. Our case provides a new perspective for healthcare professionals when evaluating patients with acromegaly. Clinicians should maintain a high index of suspicion for cancers including melanoma, and careful screening should be an important part of the management in acromegalic patients.

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Unstoppable growth: A rare case of metastatic melanoma in a patient with acromegaly

Background: Acromegaly is a growth disorder characterized by overproduction of growth hormone and IGF-1. Such overproduction of growth factors has been linked to several types of malignancy, most commonly, thyroid, colorectal, and breast neoplasms. While research does favor the increased incidence of cancer in acromegaly patients, the association with malignant melanoma is not well understood. With present a unique case of metastatic melanoma in a patient with acromegaly, as such cases are exceedingly rare in the literature.

Case presentation: A 41-year-old male with a past medical history of acromegaly, status post pituitary tumor resection, presented to the emergency department with severe back pain and right lower extremity weakness for one month. On physical examination the patient had characteristic features of acromegaly including tall body habitus, large hands, and scoliosis of the spine. He displayed decreased strength in the right lower extremity and decreased sensation at the level of T9. An MRI of the thoracic spine revealed enhancing vertebral lesions of T6 and T7, and extradural mass causing severe cord compression on the right side. Further imaging revealed right-sided lung, and liver lesions as well as leptomeningeal metastases in the left cerebral hemisphere. Patient was seen by Neurosurgery and underwent debulking surgery of the tumor in his spine. Biopsies taken from one of the metastatic lung lesions, and from the spinal cord tumor revealed metastatic melanoma on histopathology. The patient remained hospitalized while undergoing physical rehabilitation with plans to begin oncological treatment upon discharge.

Conclusions: Patients with acromegaly are at high risk for complications, and recent research studies have shown that malignancy; thyroid and colon cancer is the number one cause of mortality in this population. Our case provides a new perspective for healthcare professionals when evaluating patients with acromegaly. Clinicians should maintain a high index of suspicion for cancers including melanoma, and careful screening should be an important part of the management in acromegalic patients.

 

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