Obesity in a patient with acromegaly: a case report
G. D. Gabaidze,
M. A. Perepelova,
E. G. Przhiyalkovskaya,
E. A. Pigarova,
A. G. Kuzmin,
O. I. Vengrzhinovskaya,
A. M. Lapshina,
L. K. Dzeranova https://doi.org/10.14341/omet13182
Abstract
Acromegaly is a severe neuroendocrine disease characterized by excessive production of the growth hormone (GH). The slow development of symptoms increases the diagnostic search up to 15 years. Permanent effect of the growth hormone on the human body can cause structural and functional disorders of organs. The main complications of acromegaly include cardiovascular, respiratory, and musculoskeletal system dysfunction, as well as impaired carbohydrate metabolism and an increased risk of developing neoplasms.
Often, nonspecific symptoms of acromegaly can be masked by other pathologies or their complications, such as obesity. An increase in subcutaneous fat, increased blood pressure, joint pain, edema, and impaired carbohydrate and lipid metabolism are observed both in acromegaly and in obesity. An additional factor in the development of obesity as a complication of acromegaly is the development of sleep apnea, which triggers a series of pathological processes that ultimately lead to Pickwickian syndrome.
We present a clinical case of a patient with acromegaly and obesity, discussing the effects of excess body weight on the course of the underlying disease, the presence of complications, and an individual approach to treatment.
About the Authors
G. D. Gabaidze
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Georgy D. Gabaidze.
11 Dm. Ulyanova street, 117292 Moscow
Competing Interests:
None
M. A. Perepelova
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Margarita A. Perepelova - MD.
Moscow
Competing Interests:
None
E. G. Przhiyalkovskaya
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Elena G. Przhiyalkovskaya - MD, PhD.
Moscow
Competing Interests:
None
E. A. Pigarova
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Ekaterina A. Pigarova - MD, PhD.
Moscow
Competing Interests:
Е.А. Пигарова — член редакционной коллегии журнала «Ожирение и метаболизм»
A. G. Kuzmin
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Anatoly G. Kuzmin - MD, PhD.
Moscow
Competing Interests:
None
O. I. Vengrzhinovskaya
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Oksana I. Vengrzhinovskaya - MD.
Moscow
Competing Interests:
None
A. M. Lapshina
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Anastasia M. Lapshina - forensic pathologist, PhD.
Moscow
Competing Interests:
None
L. K. Dzeranova
Endocrinology research centre
Russian Federation
Competing Interests:
Russian Federation
Larisa K. Dzeranova - MD, PhD.
Moscow
Competing Interests:
Л.К. Дзеранова — заведующая редакцией журнала «Ожирение и метаболизм»
References
1. Fighting obesity as a direction of national health care development. Obesity and metabolism. 2022;19(1):4-6. (In Russ.) doi: https://doi.org/10.14341/omet12865
2. Przhiyalkovskaya EG, Mokrysheva NG, Troshina EA, Melnichenko GA, Dedov II, et al. Guidelines on diagnostics and treatment of acromegaly (draft). Obesity and metabolism. 2024;21(2):215-249. (In Russ.). doi: https://doi.org/10.14341/omet13153
3. Kubota N, Yano W, Kubota T, Yamauchi T, Itoh S, et al. Adiponectin stimulates AMP-activated protein kinase in the hypothalamus and increases food intake. Cell Metab. 2007;6(1):55-68. doi: https://doi.org/10.1016/j.cmet.2007.06.003
4. Kamenický P, Mazziotti G, Lombès M, Giustina A, Chanson P. Growth hormone, insulin-like growth factor-1, and the kidney: pathophysiological and clinical implications. Endocr Rev. 2014;35(2):234-81. doi: https://doi.org/10.1210/er.2013-1071
5. Zhang D, Wei Y, Huang Q, et al. Important Hormones Regulating Lipid Metabolism. Molecules. 2022. doi: https://doi.org/10.3390/molecules27207052
6. Kopchick JJ, Berryman DE, Puri V, Lee KY, Jorgensen JOL. The effects of growth hormone on adipose tissue: old observations, new mechanisms. Nat Rev Endocrinol. 2020;16(3):135-146. doi: https://doi.org/10.1038/s41574-019-0280-9
7. Esposito D, Boguszewski CL, Colao A, Fleseriu M, Gatto F, et al. Diabetes mellitus in patients with acromegaly: pathophysiology, clinical challenges and management. Nat Rev Endocrinol. 2024;20(9):541-552. doi: https://doi.org/10.1038/s41574-024-00993-x
8. Dreval AV, Trigolosova IV, Vinogradova AV, Ilovaiskaya IA, Tisheninova RS. Features of glucose metabolism in acromegaly depending on the type of treatment. Obesity and metabolism. 2013;10(4):21-25. (In Russ.) doi: https://doi.org/10.14341/omet2013421-25
9. Mandal AK, Leask MP, Sumpter NA, Choi HK, Merriman TR, Mount DB. Genetic and physiological effects of insulin-like growth factor-1 (IGF-1) on human urate homeostasis. J Am Soc Nephrol. 2023;34(3):451–466. doi: https://doi.org/10.1681/ASN.0000000000000054
10. Yuen KC, Dunger DB. Therapeutic aspects of growth hormone and insulin-like growth factor-I treatment on visceral fat and insulin sensitivity in adults. Diabetes Obes Metab. 2007;9(1):11-22. doi: https://doi.org/10.1111/j.1463-1326.2006.00591.x.
11. Freda PU. The acromegaly lipodystrophy. Front Endocrinol (Lausanne). 2022;13:933039. doi: https://doi.org/10.3389/fendo.2022.933039
12. Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnoea: a review. JAMA. 2020; 323(14): 1389-1400
13. Khiyami A, Fazeli P, Mahmud H, Gardner P, Zenonos G. ODP319 IGF-1 and BMI are Associated in Obese Patients with Acromegaly. J Endocr Soc. 2022;6(Supplement_1):A494-A495. doi: https://doi.org/10.1210/jendso/bvac150.1028
14. Akset M, Poppe KG, Kleynen P, Bold I, Bruyneel M. Endocrine disorders in obstructive sleep apnoea syndrome: A bidirectional relationship. Clin Endocrinol (Oxf). 2023;98(1):3-13. doi: https://doi.org/10.1111/cen.14685
15. Khan SA, Ram N, Masood MQ, Islam N. Prevalence of comorbidities among patients with Acromegaly. Pak J Med Sci. 2021;37:1758–61
16. Lecube A, Vilallonga R, Sturniolo G, Obiols G, Fort JM. Renaissance of acromegaly after bariatric surgery. Endocrine. 2013;43(1):239-41. doi: https://doi.org/10.1007/s12020-012-9759-z
17. Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006;85(5):1319-1340. doi: https://doi.org/10.1016/j.fertnstert.2005.10.054
18. Genchi VA, Rossi E, Lauriola C, D’Oria R, Palma G, et al. Adipose Tissue Dysfunction and Obesity-Related Male Hypogonadism. Int J Mol Sci. 2022;23(15):8194. doi: https://doi.org/10.3390/ijms23158194
19. Salvio G, Martino M, Balercia G, et al. Acromegaly and male sexual health. Rev Endocr Metab Disord. 2022;23:671–678. doi: https://doi.org/10.1007/s11154-022-09721-0
20. Mokhlesi B. Obesity hypoventilation syndrome: a state-of-the-art review. Respir Care. 2010;55(10):1347-62
21. Ragonese M, Grottoli S, Maffei P, Alibrandi A, Ambrosio MR, et al. How to improve effectiveness of pegvisomant treatment in acromegalic patients. J Endocrinol Invest. 2018;41(5):575-581. doi: https://doi.org/10.1007/s40618-017-0773-0
22. Parkinson C, Whatmore AJ, Yates AP, Drake WM, Brabant G, et al. The effect of pegvisomant-induced serum IGF-I normalization on serum leptin levels in patients with acromegaly. Clin Endocrinol (Oxf). 2003;59(2):168-74. doi: https://doi.org/10.1046/j.1365-2265.2003.01795.x
23. Bredella MA, Schorr M, Dichtel LE, Gerweck AV, Young BJ, et al. Body Composition and Ectopic Lipid Changes With Biochemical Control of Acromegaly. J Clin Endocrinol Metab. 2017;102(11):4218-4225. doi: https://doi.org/10.1210/jc.2017-01210
24. Reyes-Vidal CM, Mojahed H, Shen W, Jin Z, Arias-Mendoza F, et al. Adipose Tissue Redistribution and Ectopic Lipid Deposition in Active Acromegaly and Effects of Surgical Treatment. J Clin Endocrinol Metab. 2015;100(8):2946-55. doi: https://doi.org/10.1210/jc.2015-1917
Supplementary files
|
|
1. Figure 1. Brain MRI scan with intravenous contrast of the parient D.: Multinodular tumor of nonhomogenous structure in the sella, suprasellar cistern, bottom of the 3rd ventricle, right cavernous sinus, sinuses of the sphenoid bone, 36x33x26 mm in size (vertical – transverse – anteroposterior), the tumor deforms, displaces and compresses the optic chiasm, deforms th medial wall of the left cavernous sinus, with less intensive contrast accumulation compared to the anterior pituitary. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(224KB)
|
Indexing metadata ▾ | |
|
|
2. Figure 2. Immunohistochemical analysis of the tissue of the pituitary adenoma of the patient D. a — staining of the cytoplasm of the tumor cells with GH antibodies; b — Ki-67. | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(553KB)
|
Indexing metadata ▾ | |
|
|
3. Figure 3. a, c — “acromegaloid” appearance changes of the patient D; b — excessive subcutaneous and visceral fat | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(365KB)
|
Indexing metadata ▾ | |
|
|
4. Figure 4. Brain MRI scan with intravenous contrast of the patient D: cystic-solid tumor of irregular shape (with predominance of cystic compenent) in the sella with para-(D, Knosp 2), ante- infrasellar growth, 18x14x20 mm in size (vertical – transverse – anteroposterior), the solid component accumulates the contrast slower than the anterior pituitary | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(275KB)
|
Indexing metadata ▾ | |
|
|
5. Figure 5. Cardiorespiratory test of the patient D. with SOMNOcheck micro CARDIO device with the registration of the nasal breathing with the nasal cannula, snoring, pulse and saturation | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(260KB)
|
Indexing metadata ▾ | |
Review
For citations:
Gabaidze G.D., Perepelova M.A., Przhiyalkovskaya E.G., Pigarova E.A., Kuzmin A.G., Vengrzhinovskaya O.I., Lapshina A.M., Dzeranova L.K. Obesity in a patient with acromegaly: a case report. Obesity and metabolism. 2024;21(3):331-338. (In Russ.) https://doi.org/10.14341/omet13182
Views:
647
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
