Polycythemia associated with
acromegaly is usually caused by the systemic manifestations of the disease, such as
sleep-apnea or concomitant
erythropoietin-secreting kidney
tumors. The recognition of underlying pathologies requires a thorough diagnostic process. We report a unique case of
acromegaly with
polycythemia, not caused by commonly described manifestations of the disease, and receding with
octreotide therapy. The medical history of 141 acromegalic patients followed by the Endocrinology Unit of the San Martino University Hospital in Genoa has been also reviewed, together with the literature evidence for similar cases. The diagnostic workflow and 2-years follow-up of a 43-years old acromegalic, polycythemic man with a history of past smoking, moderate
hypertension, and
mental retardation are described. The hematological parameters of our cohort was retrospectively compared with those of a healthy, age/gender-related control group as well.
Therapy with
octreotide LAR, 20 mg i.m. q28d was begun soon after diagnosis of
acromegaly in the polycythemic patient. Haematocrit level, hormonal setting, as well as
pituitary tumor size and visual perimetry during treatment were recorded.
Octreotide LAR treatment normalized hormonal alterations, as well as hematological parameters.
Polycythemia has not recurred after 2 years of
therapy. The median
hemoglobin and hematocrit levels of the retrospectively analyzed cohort of acromegalic were significantly lower than normal ranges of a healthy, age/sex- related control population. In conclusions,
polycythemia can be a direct, albeit rare, secondary manifestation of
acromegaly, that must be considered during the diagnostic work-up of acromegalic patients presenting with such disorder.