GH-secreting pituitary macroadenoma (acromegaly) associated with progressive dental malocclusion and refractory CPAP treatment
Miranda-Rius, Jaume (Universitat de Barcelona)
Brunet-Llobet, Lluís (Hospital Sant Joan de Déu (Esplugues de Llobregat, Catalunya))
Lahor-Soler, Eduard (Universitat de Barcelona)
de Dios-Miranda, David (Universitat Autònoma de Barcelona)
Giménez-Rubio, Josep Anton (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))

Date:	2017
Abstract:	A link between progressive dental malocclusion, the use of a continuous positive airway pressure mask and GH-secreting pituitary macroadenoma (acromegaly) has not been previously reported. The present clinicopathological analysis stresses that tooth malposition should not be seen exclusively as a local process. A 62-year-old caucasian man with no relevant medical history reported difficulty chewing food and perceived voice alteration during his annual periodontal check-up. He also referred stiffness of the tongue, face, and submandibular area. The patient had been diagnosed with obstructive sleep apnea syndrome two years previously, since when he had worn a continuous positive airway pressure device during sleep. Exploration of the occlusion revealed significant changes: an atypical left lateral and anterior open bite with major buccoversion of teeth 33, 34, 35, 36. Inspection of the soft tissue revealed only macroglossia, although external palpation indicated a subcutaneous stiffness of the submandibular area. General analytical tests, including hormone profiles, and magnetic resonance imaging confirmed the diagnosis of acromegaly induced by a pituitary adenoma. Intrasellar tumor resection via transsphenoidal approach was performed. After surgery, the patient already noted a marked improvement of all symptoms associated with the acromegaly. Desaturation data also evolved favourably and the pulmonologist advised the patient to abandon the continuous positive airway pressure treatment. Progressive dental malocclusion may be associated with a systemic disease and the use of a nasal mask with premaxillary support may distort the diagnosis of acromegaly.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Dental malocclusion ; CPAP mask user ; Obstructive sleep apnea syndrome ; Acromegaly ; Pituitary adenoma
Published in:	Head & face medicine, Vol. 13 (may 2017) , ISSN 1746-160X

DOI: 10.1186/s13005-017-0140-6
PMID: 28490347

7 p, 2.0 MB

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