Ectopic growth hormone-releasing hormone secretion by a metastatic bronchial carcinoid tumor: a case with a non hypophysial intracranial tumor that shrank during long acting octreotide treatment

Ectopic acromegaly represents less than 1% of the reported cases of acromegaly. Although clinical improvement is common after treatment with somatostatin (SMS) analogs, the biochemical response and tumor size of the growth hormone-releasing hormone (GHRH)-producing tumor and its metastases are less predictable. Subject A 36-year-old male was referred because of a 3-year history of acromegaly related symptoms. He had undergone lung surgery in 1987 for a "benign" carcinoid tumor. Endocrine evaluation confirmed acromegaly Plasma IGF-1: 984 ng/ml (63-380), GH: 49.8 ng/ml (<5). MRI showed a large mass in the left cerebellopontine angle and diffuse pituitary hyperplasia. Pulmonary, liver and bone metastases were shown by chest and abdominal CT scans. Ectopic GHRH secretion was suspected. Methods Measurement of circulating GHRH levels by fluorescence immunoassay levels and immunohistochemical study of the primary lung tumor and metastatic tissue with anti-GHRH and anti-somatostatin receptor type 2 (sst2A) antibodies. Results Basal plasma GHRH: 4654 pg/ml (<100). Pathological study of liver and bone biopsy material and lung tissue removed 19 years earlier was consistent with an atypical carcinoid producing GHRH and exhibiting sst2A receptor expression. Treatment with octreotide LAR 20-40 mg q. month resulted in normalization of plasma IGF-1 levels. Circulating GHRH levels decreased dramatically. The size of the left prepontine cistern mass, with SMS receptors shown by a radiolabeled pentetreotide scan, decreased by 80% after 18 months of therapy. Total regression of pituitary enlargement was also observed. No changes were observed in lung and liver metastases. After 24 months of therapy the patient is asymptomatic and living a full and active life

Enhancing Clinical Decision-Making in LATAM through Virtual Genitourinary Tumour Boards

Inequity in cancer care access among LATAM countries is huge. Experience with gastrointestinal tumors in Latin America has shown care disparities can be reduced by equalizing access to high-quality medical knowledge in a context of a multidisciplinary environment for medical discussions.Here, we describe our experience of working with virtual genitourinary multidisciplinary tumor boards (vGUMDT), including how the virtual board has helped with clinical decision-making.We describe vGUMDT ́s experience and the importance of basing clinical decision-making in the consultant’s own center, reducing the need for referrals.In total, 345 cases were presented. The majority were prostate cancer cases, and the median age of patients was 64 years. Five participating centers were in Buenos Aires, 7 were in other cities in Argentina (Neuquén, Mendoza, Formosa, Salta, Santa Fé, Entre Ríos, Córdoba), and 3 centers were located in other countries in South America (Perú, Colombia, and Paraguay). Median distance from treating center to vGUMDT headquarters was 1289.8 km. A few patients (n = 60, 17.3%) were referred to the Alexander Fleming Cancer Institute or tertiary health care centers for surgery or systemic therapy, and a minority of cases were referred for radiotherapy. Multidisciplinary virtual experiences, such as vGUMDT, should be carefully addressed by health care decision-makers, given their popularity and their demonstrated cost-effectiveness