GH-secreting pituitary macroadenoma (acromegaly) associated with progressive dental malocclusion and refractory CPAP treatment.
Por:
Miranda-Rius J, Brunet Ll, Lahor-Soler E, de Dios-Miranda D and Giménez-Rubio JA
Publicada:
10 may 2017
Ahead of Print:
10 may 2017
Resumen:
BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSION: 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.
Filiaciones:
Miranda-Rius J:
Department of Odontostomatology, Faculty of Medicine & Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Brunet Ll:
Division of Orthodontics and Paediatric Dentistry, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
Lahor-Soler E:
Department of Odontostomatology, Faculty of Medicine & Health Sciences, Universitat de Barcelona, Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
de Dios-Miranda D:
Bachelor of Science, Health Sciences Program, Universitat Autònoma de Barcelona, Barcelona, Spain
Giménez-Rubio JA:
Chief of Oral and Maxillofacial Department, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
Open Access
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