말단비대증 환자에서 발생한 급성 림프구백혈병 1예
Acute Lymphoblastic Leukemia Diagnosed in a Patient with Acromegaly
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초록
말단비대증은 뇌하수체 전엽의 종양에서 성장호르몬을 과도하게 분비하여 얼굴이나 손발의 말단부 및 장기의 비대를 초래하는 내분비질환으로 한국에서 유병률 백만 명당 27.9예, 발병률은 년당 인구 백만 명당 3.9명으로 보고된 바 있다[1]. 말단비대증 환자는 성장호르몬과 인슐린유사성장인자-1의 증가로 심혈관계나 호흡기계, 악성종양의 합병증을 동반하여 사망률이 증가한다. 악성종양 중에서 대장암, 갑상선암, 유방암 등이 말단비대증과 연관되어 유병률이 높은 것으로 보고되고 있다[2]. 말단비대증과 관련된 급성 백혈병은 전 세계적으로 드물게 몇 건이 보고되어 있으며 국내에서는 보고된 바가 없다. 저자들은 말단비대증 환자에서 급성 림프구백혈병을 진단하고 항암 치료 및 골수이식을 경험하였기에 이에 대한 문헌고찰과 함께 보고하고자 한다.
Abstract
Acromegaly is a rare disorder caused by excessive amounts of growth hormone. The incidence of colorectal, breast, and thyroid carcinomas is increased in acromegaly. However, there have been few reports on hematological malignancies in acromegaly. We describe a patient who developed acute lymphoblastic leukemia during the course of acromegaly. A 35-year-old woman presented in February 2012 with unexplained lactation and amenorrhea for 4 months. Her growth hormone level was 12.6 μg/L, insulin-like growth factor 1 592.26 ng/mL, and prolactin 242 μg/L. A pituitary macroadenoma secreting GH and prolactin causing acromegaly was diagnosed. Considering her fertility, the dopamine agonist cabergoline 0.5 mg was administered in March 2012. In February 2014, she presented with cytopenia (hemoglobin 12.2 g/dL, white cell count 2.69 × 109/L, platelets 39 × 109/L) and hepatosplenomegaly. A bone marrow examination showed acute B cell lymphoblastic leukemia. She underwent chemotherapy and bone marrow transplantation. A follow-up bone marrow biopsy showed remission.
참고문헌 (10)
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