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Incidental Growth Hormone Producing Pituitary Adenoma in a Case of Recurrent Nodular Goiter and Thyroid Carcinoma

Rachel T Bond, Stavroula Christopoulos and Michael Tamilia

Objective: Studies report an increased prevalence of thyroid tumors among patients with acromegaly.
Acromegaly often has a subtle presentation and is likely underdiagnosed. This report highlights the development of recurrent thyroid neoplasia in a patient with undiagnosed acromegaly and raises awareness of thyroid malignancy in patients with acromegaly.
Case report: Mrs. R is a 47-year-old woman who presented with a recurrent goiter following two partial
thyroidectomies, then was diagnosed with acromegaly and subsequently papillary thyroid cancer.
Methods: A review of the English-language literature on the PubMed database of acromegaly and thyroid cancerwas performed. DNA from the tumor and adjacent benign thyroid tissue was tested by polymerase chain reaction(PCR)/direct sequencing of genomic DNA for genetic abnormalities.
Results: The relationship between the Growth Hormone (GH)/Insulin-like Growth Factor 1 (IGF-1) axis and the thyroid hyperplasia and neoplasia was detailed. The increased risk of malignancy occurs under the influence ofspecific goitrogens namely, prolonged GH/IGF-1 exposure.
Conclusion: The reported link between acromegaly and thyroid tumors should raise suspicion of malignancy inacromegalic patients with thyroid nodules. Additionally, an increased suspicion of acromegaly should be entertainedin patients with recurrent thyroid nodular hyperplasia following partial thyroidectomy.