Delayed diagnosis of acromegaly in a patient with focal segmental Glomerulosclerosis: a rare case report and literature review.

Abstract

BACKGROUND:

Experimental studies have demonstrated that hypersecretion of growth hormone (GH) is associated with development of glomerular sclerosis. However, clinical case of such condition is very rare. Here we presented a case of focal segmental glomerulosclerosis (FSGS) associated with acromegaly.

CASE PRESENTATION:

A 63-year-old man was diagnosed as nephrotic syndrome with minimal change disease for 2 years. Prednisone 1 mg/kg/day for 9 months led to no response. After admission, the second kidney biopsy indicated FSGS (NOS variant). On admission, his acromegalic features were noticed and he complained with a 20-year history of soft tissue swelling of hands and feet. Serum GH and insulin-like growth factor 1 (IGF-1) concentrations were both elevated significantly. An oral glucose tolerance test showed inadequate suppression of serum GH. The presence of a pituitary macroadenoma with a diameter of 1.4 cm by MRI confirmed the diagnosis of acromegaly. Then, the tumor was subtotally removed by trans-sphenoidal surgery. Partial remission of proteinuria was achieved 3 months after surgery and maintained during follow-up, with gradual reduce of corticosteroid.

CONCLUSIONS:

This rare case suggested that the hypersecretion of GH may participate, at least in part, in FSGS development and progression. Early diagnosis and treatment of acromegaly is beneficial.

• Authors: Jia Zheng, Zhao Cui, Ji-Cheng Lv, Hong-Zhou Duan, Su-Xia Wang, Jun-Qing Zhang, Fu-de Zhou, Xiao-Hui Guo, Ming-Hui Zhao
• Journal: BMC nephrology (BMC Nephrol) Vol. 20 Issue 1 Pg. 435 (11 27 2019) ISSN: 1471-2369 [Electronic] England
• PMID: 31771524 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• IGF1 protein, human
• Human Growth Hormone
• Insulin-Like Growth Factor I

Topics

• Acromegaly (blood, diagnosis, etiology)
• Adenoma (blood, pathology, surgery)
• Diagnosis, Differential
• Glomerulosclerosis, Focal Segmental (diagnosis, etiology, therapy)
• Glucose Tolerance Test
• Human Growth Hormone (analysis)
• Humans
• Hypophysectomy (methods)
• Insulin-Like Growth Factor I (analysis)
• Kidney (pathology)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Nephrotic Syndrome (diagnosis, etiology)
• Pituitary Gland (diagnostic imaging)
• Pituitary Neoplasms (blood, pathology, surgery)
• Treatment Outcome