Timing of Surgical Approach on Patients with Somatotropinoma and Differentiated Thyroid Cancer

Acromegaly is a rare chronic, progressive disease caused by the increased secretion of growth hormone (GH) and subsequently insulin-like growth factor 1 (IGF-1). Benign thyroid overgrowth is a common phenomenon in this pathology, but some studies revealed that acromegaly is associated with an increase in the prevalence of malignant thyroid nodules. We present two cases of acromegaly associated with papillary thyroid carcinoma. A 69-year-old female accused at the age of 43 headache, enlarged hands and feet, secondary amenorrhea. The investigations revealed high IGF-1 and GH levels and a pituitary GH producing macroadenoma. 19 years after transsphenoidal adenomectomy, a multinodular goiter with areas of calcifications and intra and perinodular vascularization were discovered. Total thyroidectomy was performed and histopathology highlighted a papillary thyroid carcinoma. A 53-year-old male was admitted at the age of 45 with intense headache, dizziness, sexual dysfunction and a multinodular goiter. Clinical signs of acromegaly were correlated to the presence of an intra-sellar tumor with extension to the optic chiasm. Transsphenoidal adenomectomy was first decided and it was followed by conventional radiotherapy, somatostatin analogue and GH blocker afterwards. For multinodular goiter a fine needle aspiration showed the need of total thyroidectomy which was further performed and a minimally invasive papillary microcarcinoma was confirmed. The relationship between acromegaly and thyroid carcinoma could be related to the stimulatory effects of long-lasting excess of IGF-1 and GH on TSH induced thyroid cellular growth. Therefore, it is necessary to carry out effective treatment and periodic thyroid ultrasound examination in patients with acromegaly; usually thyroidectomy follows hypophysectomy to achieve GH control first.