Secondary erythrocytosis in patient with acromegaly
A 53-year old man with acromegaly was referred for neurosurgical treatment. At admission: growth hormone (GH) 240 ME/l at all time points of glucose tolerance test, IGF-1 - 415,1 ng/ml, brain MRI showed pituitary adenoma 34×32×27 mm extending suprasellar, deforming and displacing optic chiasm, parasellar to both cavernous sinuses and surrounding left internal carotid artery. Clinical blood tests revealed marked erythrocytosis - 6.1×1012, Hb - 200 g/l, HCT - 62%; urobilinigen 50 mmol/l was found in urine; otherwise the tests were normal. For exclusion of erythraemia the patient underwent trepanobiopsy of bone marrow which showed normal haemopoesis and suggested a secondary nature of erythrocytosis. In preoperative period 1100 ml of blood were evacuated by phlebotomy in 4 sessions, which resulted in reduction of erythrocyte count to 5,1×1012, Hb 160 g/l, HCT 50% and disappearance of urobilinigen. The patient was then operated by transnasal approach with debulking of most adenomatous tissue but without biochemical remission of acromegaly (GH 92-99 at glucose tolerance test). A week after surgery - erythrocytes 4,5×1012, Hb - 141 g/l, HCT - 44,1%. The patient was prescribed a octreotide depo (Sandostatin LAR) injections 20 mg/mth and at 6 months from operation was feeling well, with clinical remission of acromegaly and normalization of IGF-1 and all blood count parameters.