Rapid Progression of Amyotrophic Lateral Sclerosis in an Acromegalic Patient After Surgical Resection of a Growth Hormone-Producing Pituitary Adenoma
INTRODUCTION:Insulin-like growth factor-1 (IGF-1) promotes the survival of neurons, mediates neuritic growth, and in 1 clinical trial human recombinant IGF-1 delayed the progression of functional impairment and decline of health-related quality of life in patients with amyotrophic lateral sclerosis...
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Veröffentlicht in: | The Neurologist (Baltimore, Md.) Md.), 2010-09, Vol.16 (5), p.315-318 |
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description | INTRODUCTION:Insulin-like growth factor-1 (IGF-1) promotes the survival of neurons, mediates neuritic growth, and in 1 clinical trial human recombinant IGF-1 delayed the progression of functional impairment and decline of health-related quality of life in patients with amyotrophic lateral sclerosis (ALS).
CASE REPORT:We describe a case of a 65-year-old woman with a 2-year history of symptoms and signs of acromegaly because of a pituitary microadenoma. The patient posed a challenging diagnostic dilemma because of the presence of dysarthria, which was initially considered as the consequence of acromegaly. After octreotide long-acting release (LAR) treatment, the patient underwent uneventful pituitary surgery. Although postoperative evaluation indicated a cure of acromegaly, progressive bulbar symptoms developed, which were followed by upper limb weakness and muscle atrophy. Neurologic investigations confirmed the diagnosis of ALS and riluzole therapy was given. One year after surgery growth-hormone deficiency was diagnosed, but a trial with human recombinant growth hormone failed to produce any significant improvement. Two years after surgery the patient died of a sudden respiratory arrest. Histopathologic examination of the brain and spinal cord confirmed the diagnosis of ALS.
CONCLUSIONS:This is the first report showing a rapid progression of ALS after a surgical cure of coexisting acromegaly presumably because of cessation of high endogenous IGF-I levels. |
doi_str_mv | 10.1097/NRL.0b013e3181b46fef |
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CASE REPORT:We describe a case of a 65-year-old woman with a 2-year history of symptoms and signs of acromegaly because of a pituitary microadenoma. The patient posed a challenging diagnostic dilemma because of the presence of dysarthria, which was initially considered as the consequence of acromegaly. After octreotide long-acting release (LAR) treatment, the patient underwent uneventful pituitary surgery. Although postoperative evaluation indicated a cure of acromegaly, progressive bulbar symptoms developed, which were followed by upper limb weakness and muscle atrophy. Neurologic investigations confirmed the diagnosis of ALS and riluzole therapy was given. One year after surgery growth-hormone deficiency was diagnosed, but a trial with human recombinant growth hormone failed to produce any significant improvement. Two years after surgery the patient died of a sudden respiratory arrest. Histopathologic examination of the brain and spinal cord confirmed the diagnosis of ALS.
CONCLUSIONS:This is the first report showing a rapid progression of ALS after a surgical cure of coexisting acromegaly presumably because of cessation of high endogenous IGF-I levels.</description><identifier>ISSN: 1074-7931</identifier><identifier>EISSN: 2331-2637</identifier><identifier>DOI: 10.1097/NRL.0b013e3181b46fef</identifier><identifier>PMID: 20827122</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Acromegaly - drug therapy ; Acromegaly - physiopathology ; Acromegaly - surgery ; Aged ; Amyotrophic Lateral Sclerosis - etiology ; Amyotrophic Lateral Sclerosis - physiopathology ; Antineoplastic Agents, Hormonal - therapeutic use ; Disease Progression ; Fatal Outcome ; Female ; Growth Hormone-Secreting Pituitary Adenoma - complications ; Growth Hormone-Secreting Pituitary Adenoma - drug therapy ; Growth Hormone-Secreting Pituitary Adenoma - surgery ; Human Growth Hormone - deficiency ; Human Growth Hormone - therapeutic use ; Humans ; Insulin-Like Growth Factor I - metabolism ; Octreotide - therapeutic use ; Pituitary Neoplasms - complications ; Pituitary Neoplasms - drug therapy ; Pituitary Neoplasms - surgery</subject><ispartof>The Neurologist (Baltimore, Md.), 2010-09, Vol.16 (5), p.315-318</ispartof><rights>2010 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3517-50052a078d13ff7230182277f453e3f130076084007638755fb7edd856311d313</citedby><cites>FETCH-LOGICAL-c3517-50052a078d13ff7230182277f453e3f130076084007638755fb7edd856311d313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20827122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mondok, Agnes</creatorcontrib><creatorcontrib>Aranyi, Zsuzsanna</creatorcontrib><creatorcontrib>Kovacs, Gabor G.</creatorcontrib><creatorcontrib>Czirjak, Sandor</creatorcontrib><creatorcontrib>Pusztai, Peter</creatorcontrib><creatorcontrib>Varga, Ibolya</creatorcontrib><creatorcontrib>Racz, Karoly</creatorcontrib><title>Rapid Progression of Amyotrophic Lateral Sclerosis in an Acromegalic Patient After Surgical Resection of a Growth Hormone-Producing Pituitary Adenoma</title><title>The Neurologist (Baltimore, Md.)</title><addtitle>Neurologist</addtitle><description>INTRODUCTION:Insulin-like growth factor-1 (IGF-1) promotes the survival of neurons, mediates neuritic growth, and in 1 clinical trial human recombinant IGF-1 delayed the progression of functional impairment and decline of health-related quality of life in patients with amyotrophic lateral sclerosis (ALS).
CASE REPORT:We describe a case of a 65-year-old woman with a 2-year history of symptoms and signs of acromegaly because of a pituitary microadenoma. The patient posed a challenging diagnostic dilemma because of the presence of dysarthria, which was initially considered as the consequence of acromegaly. After octreotide long-acting release (LAR) treatment, the patient underwent uneventful pituitary surgery. Although postoperative evaluation indicated a cure of acromegaly, progressive bulbar symptoms developed, which were followed by upper limb weakness and muscle atrophy. Neurologic investigations confirmed the diagnosis of ALS and riluzole therapy was given. One year after surgery growth-hormone deficiency was diagnosed, but a trial with human recombinant growth hormone failed to produce any significant improvement. Two years after surgery the patient died of a sudden respiratory arrest. Histopathologic examination of the brain and spinal cord confirmed the diagnosis of ALS.
CONCLUSIONS:This is the first report showing a rapid progression of ALS after a surgical cure of coexisting acromegaly presumably because of cessation of high endogenous IGF-I levels.</description><subject>Acromegaly - drug therapy</subject><subject>Acromegaly - physiopathology</subject><subject>Acromegaly - surgery</subject><subject>Aged</subject><subject>Amyotrophic Lateral Sclerosis - etiology</subject><subject>Amyotrophic Lateral Sclerosis - physiopathology</subject><subject>Antineoplastic Agents, Hormonal - therapeutic use</subject><subject>Disease Progression</subject><subject>Fatal Outcome</subject><subject>Female</subject><subject>Growth Hormone-Secreting Pituitary Adenoma - complications</subject><subject>Growth Hormone-Secreting Pituitary Adenoma - drug therapy</subject><subject>Growth Hormone-Secreting Pituitary Adenoma - surgery</subject><subject>Human Growth Hormone - deficiency</subject><subject>Human Growth Hormone - therapeutic use</subject><subject>Humans</subject><subject>Insulin-Like Growth Factor I - metabolism</subject><subject>Octreotide - therapeutic use</subject><subject>Pituitary Neoplasms - complications</subject><subject>Pituitary Neoplasms - drug therapy</subject><subject>Pituitary Neoplasms - surgery</subject><issn>1074-7931</issn><issn>2331-2637</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQxi0EokvhDRDyjVPKjJ3EyTGqaIu0gtUWzpE3Ge8anHixHa36ILwvrrqAxGE0l-_75s-PsbcIVwit-vB5u76CHaAkiQ3uytqQecZWQkosRC3Vc7ZCUGWhWokX7FWM3wGwrUX5kl0IaIRCIVbs11Yf7cg3we8DxWj9zL3h3fTgU_DHgx34WicK2vH7wVHw0UZuZ65n3g3BT7TXLms2OlmaE-9M1vL7JeztkC1bijSkc6bmt8Gf0oHf-TD5mYo8c1wGO-_5xqbFJh0eeDfS7Cf9mr0w2kV6c-6X7NvNx6_Xd8X6y-2n625dDLJCVVQAldCgmhGlMUpIwEYIpUxZ5a8YlACqhqZ8bLJRVWV2isaxqWqJOEqUl-z9U-4x-J8LxdRPNg7knJ7JL7FXVQlCtarKyvJJma-OMZDpj8FOeeUeoX_k0Wce_f88su3decCym2j8a_oD4F_uybv8u_jDLScK_YG0S4c-ExOqaWUhAAFaAChygZK_Aa4rmAw</recordid><startdate>201009</startdate><enddate>201009</enddate><creator>Mondok, Agnes</creator><creator>Aranyi, Zsuzsanna</creator><creator>Kovacs, Gabor G.</creator><creator>Czirjak, Sandor</creator><creator>Pusztai, Peter</creator><creator>Varga, Ibolya</creator><creator>Racz, Karoly</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201009</creationdate><title>Rapid Progression of Amyotrophic Lateral Sclerosis in an Acromegalic Patient After Surgical Resection of a Growth Hormone-Producing Pituitary Adenoma</title><author>Mondok, Agnes ; Aranyi, Zsuzsanna ; Kovacs, Gabor G. ; Czirjak, Sandor ; Pusztai, Peter ; Varga, Ibolya ; Racz, Karoly</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3517-50052a078d13ff7230182277f453e3f130076084007638755fb7edd856311d313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acromegaly - drug therapy</topic><topic>Acromegaly - physiopathology</topic><topic>Acromegaly - surgery</topic><topic>Aged</topic><topic>Amyotrophic Lateral Sclerosis - etiology</topic><topic>Amyotrophic Lateral Sclerosis - physiopathology</topic><topic>Antineoplastic Agents, Hormonal - therapeutic use</topic><topic>Disease Progression</topic><topic>Fatal Outcome</topic><topic>Female</topic><topic>Growth Hormone-Secreting Pituitary Adenoma - complications</topic><topic>Growth Hormone-Secreting Pituitary Adenoma - drug therapy</topic><topic>Growth Hormone-Secreting Pituitary Adenoma - surgery</topic><topic>Human Growth Hormone - deficiency</topic><topic>Human Growth Hormone - therapeutic use</topic><topic>Humans</topic><topic>Insulin-Like Growth Factor I - metabolism</topic><topic>Octreotide - therapeutic use</topic><topic>Pituitary Neoplasms - complications</topic><topic>Pituitary Neoplasms - drug therapy</topic><topic>Pituitary Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mondok, Agnes</creatorcontrib><creatorcontrib>Aranyi, Zsuzsanna</creatorcontrib><creatorcontrib>Kovacs, Gabor G.</creatorcontrib><creatorcontrib>Czirjak, Sandor</creatorcontrib><creatorcontrib>Pusztai, Peter</creatorcontrib><creatorcontrib>Varga, Ibolya</creatorcontrib><creatorcontrib>Racz, Karoly</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Neurologist (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mondok, Agnes</au><au>Aranyi, Zsuzsanna</au><au>Kovacs, Gabor G.</au><au>Czirjak, Sandor</au><au>Pusztai, Peter</au><au>Varga, Ibolya</au><au>Racz, Karoly</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rapid Progression of Amyotrophic Lateral Sclerosis in an Acromegalic Patient After Surgical Resection of a Growth Hormone-Producing Pituitary Adenoma</atitle><jtitle>The Neurologist (Baltimore, Md.)</jtitle><addtitle>Neurologist</addtitle><date>2010-09</date><risdate>2010</risdate><volume>16</volume><issue>5</issue><spage>315</spage><epage>318</epage><pages>315-318</pages><issn>1074-7931</issn><eissn>2331-2637</eissn><abstract>INTRODUCTION:Insulin-like growth factor-1 (IGF-1) promotes the survival of neurons, mediates neuritic growth, and in 1 clinical trial human recombinant IGF-1 delayed the progression of functional impairment and decline of health-related quality of life in patients with amyotrophic lateral sclerosis (ALS).
CASE REPORT:We describe a case of a 65-year-old woman with a 2-year history of symptoms and signs of acromegaly because of a pituitary microadenoma. The patient posed a challenging diagnostic dilemma because of the presence of dysarthria, which was initially considered as the consequence of acromegaly. After octreotide long-acting release (LAR) treatment, the patient underwent uneventful pituitary surgery. Although postoperative evaluation indicated a cure of acromegaly, progressive bulbar symptoms developed, which were followed by upper limb weakness and muscle atrophy. Neurologic investigations confirmed the diagnosis of ALS and riluzole therapy was given. One year after surgery growth-hormone deficiency was diagnosed, but a trial with human recombinant growth hormone failed to produce any significant improvement. Two years after surgery the patient died of a sudden respiratory arrest. Histopathologic examination of the brain and spinal cord confirmed the diagnosis of ALS.
CONCLUSIONS:This is the first report showing a rapid progression of ALS after a surgical cure of coexisting acromegaly presumably because of cessation of high endogenous IGF-I levels.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>20827122</pmid><doi>10.1097/NRL.0b013e3181b46fef</doi><tpages>4</tpages></addata></record> |
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subjects | Acromegaly - drug therapy Acromegaly - physiopathology Acromegaly - surgery Aged Amyotrophic Lateral Sclerosis - etiology Amyotrophic Lateral Sclerosis - physiopathology Antineoplastic Agents, Hormonal - therapeutic use Disease Progression Fatal Outcome Female Growth Hormone-Secreting Pituitary Adenoma - complications Growth Hormone-Secreting Pituitary Adenoma - drug therapy Growth Hormone-Secreting Pituitary Adenoma - surgery Human Growth Hormone - deficiency Human Growth Hormone - therapeutic use Humans Insulin-Like Growth Factor I - metabolism Octreotide - therapeutic use Pituitary Neoplasms - complications Pituitary Neoplasms - drug therapy Pituitary Neoplasms - surgery |
title | Rapid Progression of Amyotrophic Lateral Sclerosis in an Acromegalic Patient After Surgical Resection of a Growth Hormone-Producing Pituitary Adenoma |
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