Effect of pituitary microsurgery on acromegaly complicated nephrotic syndrome with focal segmental glomerulosclerosis: Report of a rare clinical case

A case of nephrotic syndrome complicated by acromegaly is presented. The fi rst renal biopsy specimen showed minor glomerular abnormalities with glomer ular hypertrophy, corresponding with minimal change nephrotic syndrome. Cor ticosteroid therapy led to a partial remission, followed by frequent relaps es after reduction of the drug. A diagnosis of atypical focal segmental glo merulosclerosis (FSGS) was made based on the second renal biopsy results 6 months after the first. We combined steroid therapy with the administration of an anticoagulant, cytotoxic agents, angiotensin-converting enzyme inhib itor, and low density lipoprotein adsorption. Except for the angiotensin-co nverting enzyme inhibitor, these medications were not effective in terms of allowing a reduction in the high dosage of steroid, which in turn threaten ed progressive osteoporosis and lumbar vertebrae fracture. Administering th e steroid at a moderate dosage, treatment was focused on the complicating a cromegaly from pituitary microadenoma. Subcutaneous injections of octreotid e acetate, a somatostatin analogue, reduced proteinuria and increased urine volume. Subsequent transsphenoidal microsurgery of the adenoma resulted in the normalization of the elevated creatinine clearance and the further red uction in steroid dosage while maintaining a remission state. This is the f irst reported clinical case with acromegaly followed by FSGS, and it is sug gested that hypersecretion of growth hormone participates in the developmen t and progression of glomerular disease. (C) 1999 by the National Kidney Fo undation, Inc.