Multidisciplinary approachto management of a patient with acromegaly and colon cancer (a clinical case)

Acromegaly is a disease that occurs due to prolonged, uncontrolled hypersecretion of growth hormone by a pituitary tumor. Acromegaly is a significant risk factor for colon cancer. A clinical case of colon adenocarcinoma diagnosed in a patient with active acromegaly is presented.
The aim was to demonstrate a multidisciplinary approach to the treatment of a patient with acromegaly when diagnosed with cancer. Clinical case. Active acromegaly due to pituitary macroadenoma (somatotropinoma) and associated type 2 diabetes mellitus were diagnosed in the 56-year-old patient. The additional examination (including colonoscopy) and transsphenoidal adenomectomy as the first-line acromegaly treatment were recommended but not performed due to restrictive measures during the pandemic (COVID-19), he was taking metformin. At age 58, a repeat examination revealed no negative dynamics in the somatotropinoma size without treatment, nevertheless, IGF-1 and HbA1c levels worsened. Colonoscopy revealed tubulovillous adenoma of the ascending colon. Treatment of diabetes mellitus was optimized, neurosurgy for acromegaly as well as polypectomy were recommended. From the set of prescriptions and recommendations, However, the patient followed the treatment of diabetes mellitus only. At age 60, after repeated colonoscopy and histological examination the malignant neoplasm of the ascending colon was diagnosed in our patient that required the primary diagnosis changing and corresponding changing in treatment tactics. Prolonged-acting somatostatin analogs were prescribed, laparoscopic right-sided hemicolectomy with subsequent active monitoring was performed. Control examinations after 3 and 6 months showed no convincing signs of cancer recurrence. Successful transnasal transsphenoidal adenomectomy was finally performed. Management of patients with acromegaly requires a multidisciplinary approach and a combination of clinical guidelines depending on the individual spectrum of concomitant comorbid diseases.

1. Przhiyalkovskaya EG, Mokrysheva NG, Troshina EA, Mel’nichenko GA, Dedov II, Antsiferov MB et al. Guidelines on diagnostics and treatment of acromegaly (draft). Obesity and Metabolism. 2024;21(2):215–249. (In Russ.) https://doi.org/10.14341/omet13153.

2. Fleseriu M, Biller BMK, Freda PU, Gadelha MR, Giustina A, Katznelson L et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021;24(1):1–13. https://doi.org/10.1007/s11102-020-01091-7.

3. Xiao Z, Xiao P, Wang Y, Fang C, Li Y. Risk of cancer in acromegaly patients: An updated meta-analysis and systematic review. PLoS ONE. 2023;18(11):e0285335. https://doi.org/10.1371/journal.pone.0285335.

4. Dornblaser D, Young S, Shaukat A. Colon polyps: updates in classification and management. Curr Opin Gastroenterol. 2024;40(1):14–20. https://doi.org/10.1097/MOG.0000000000000988.

5. Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer. Gastrointest Endosc Clin N Am. 2022;32(2):177–194. https://doi.org/10.1016/j.giec.2021.12.001.

6. Yusupova NZ, Giniyatullina NZ. Analysis current understanding of the role of various risk factors in the development of colorectal cancer (literature review). Journal of New Medical Technologies. 2020;(4):5–10. (In Russ.) https://doi.org/10.24411/1609-2163-2020-16698.

7. Basu R, Boguszewski CL, Kopchick JJ. Growth Hormone Action as a Target in Cancer: Significance, Mechanisms, and Possible Therapies. Endocr Rev. 2025;46(2):224–280. https://doi.org/10.1210/endrev/bnae030.

8. Sninsky JA, Shore BM, Lupu GV, Crockett SD. Risk Factors for Colorectal Polyps and Cancer. Gastrointest Endosc Clin N Am. 2022;32(2):195–213. https://doi.org/10.1016/j.giec.2021.12.008.

9. Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020;105(4):dgz096. https://doi.org/10.1210/clinem/dgz096.

10. Krivosheeva YG, Ilovayskaya IA. Primary signs of pituitary macroadenomas of different hormonal activity and specialists to whom patients referred at the first time. Medical Herald of the South of Russia. 2022;13(1):65–71. (In Russ.) https://doi.org/10.21886/2219-8075-2022-13-1-65-71.

11. Kasuki L, Maia B, Gadelha MR. Acromegaly and Colorectal Neoplasm: An Update. Front Endocrinol. 2022;13:924952. https://doi.org/10.3389/fendo.2022.924952.

12. Fedyanin MYu, Gladkov OA, Gordeev SS, Karachun AM, Kozlov NA, Mammadli ZZ et al. Cancer of the colon, rectosigmoid junction and rectum. Malignant Tumors. 2024;14(3s2-1):263–322. (In Russ.) https://doi.org/10.18027/2224-5057-2024-14-3s2-1.1-14.

13. Huck MB, Bohl JL. Colonic Polyps: Diagnosis and Surveillance. Clin Colon Rectal Surg. 2016;29(4):296–305. https://doi.org/10.1055/s-0036-1584091.

14. Kit OI, Gevorkyan YuA, Soldatkina NV, Legostaev VM, Kolesnikov EN, Bondarenko OK et al. Treatment of cancer in tubular villous colorectal adenomas. Pirogov Russian Journal of Surgery. 2025;(9):29–35. (In Russ.) https://doi.org/10.17116/hirurgia202509129.

15. Maia B, Madeira E, Gadelha MR, Kasuki L. Assessment of the frequency and risk factors for colorectal cancer in acromegaly. Endocrine. 2025;87(3):1162–1170. https://doi.org/10.1007/s12020-024-04099-2.