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CASE REPORT
Hypersomatotropism induced secondary polycythaemia leading to spontaneous pituitary apoplexy resulting in cure of acromegaly and remission of polycythaemia: ‘The virtuous circle’
  1. Shinjan Patra,
  2. Sugata Narayan Biswas,
  3. Joydip Datta,
  4. Partha Pratim Chakraborty
  1. Department of Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
  1. Correspondence to Dr Partha Pratim Chakraborty, docparthapc{at}yahoo.co.in

Summary

A young man with subtle clinical features suggestive of hypersomatotropism presented with acute-onset severe headache. Relevant investigations confirmed polycythaemia and growth hormone (GH)-secreting pituitary macroadenoma with apoplexy. Secondary polycythaemia and myeloproliferative disorders were ruled out. At follow-up after 3 months, resolution of polycythaemia and acromegaly was observed, evident on normal haemoglobin levels, a normocellular marrow, and normal insulin-like growth factor-1 (IGF-1) with glucose-suppressed GH levels. Direct mitogenic properties of GH-IGF-1 axis on bone marrow progenitor cells may very rarely lead to erythroid hyperplasia and subsequent polycythaemia, reversible with successful therapy of acromegaly. In this case, polycythaemia secondary to hypersomatotropism likely resulted in pituitary apoplexy with subsequent remission of both acromegaly and resultant polycythaemia.

  • pituitary disorders
  • haematology (incl blood transfusion)

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Footnotes

  • Contributors SP, SNB, JD and PPC were involved in diagnosis and management of the patient. SP, SNB and PPC were involved in literature search and writing of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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