“Endoscopy in Endocrinology.” A rare case of Hamartomatous Gastric Polyp in an Acromegaly Patient

Mateo Te III, MD , Mark Anthony De Lusong, MD, FPCP, FPSG, FPSDE
UP-PGH

Clinical Presentation: This case highlights the role of endoscopy in correlation with patient’s clinical presentation in the consideration and diagnosis of acromegaly. A 64-year-old female sought consultation for work up of occult GI bleeding presenting as symptomatic anemia. She underwent EGD revealing multiple diminutive gastric polyps and a two-centimeter pedunculated polypoid mass at the gastric body. On colonoscopy, a one-centimeter sessile polyp at sigmoid colon was removed by snare polypectomy. She was referred to advanced endoscopy and underwent endo loop assisted snare polypectomy of the pedunculated polypoid mass which turned out to be hamartomatous polyp on histopathology. On review of systems during the admission; patient had been complaining about deepening of her voice and having coarse facial features. She was eventually referred to endocrinology and further work ups done to her (pituitary mass on Cranial MRI and elevated IGF) are consistent with acromegaly. She then underwent transsphenoidal excision of the pituitary mass and was sent home improved. Prevalence of colonic polyps is significantly high in acromegaly between 14-35%. Consensus guidelines include colonoscopy as part of the standard of care in evaluating patients with acromegaly. Gastric polyps, commonly fundic gland polyps, are also associated with acromegaly however there have been no documented cases presenting as hamartomatous histopathology. In general, gastric hamartomatous polyps are uncommon and comprise only about 1% of all the stomach polyps. After extensive literature review, this is the first documented case of hamartomatous gastric polyp in a patient with acromegaly.

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