{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T12:14:27Z","timestamp":1789215267895,"version":"build-2803163510"},"reference-count":40,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T00:00:00Z","timestamp":1654214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004281","name":"National Science Centre of Poland","doi-asserted-by":"crossref","award":["UMO-2018\/28\/T\/NZ5\/00304"],"award-info":[{"award-number":["UMO-2018\/28\/T\/NZ5\/00304"]}],"id":[{"id":"10.13039\/501100004281","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Acromegaly due to ectopic secretion of growth hormone-releasing hormone (GHRH) is rare. Treatment consists of surgical removal of the primary tumor, cytostatic therapy, \u201ccold\u201d or radioactive somatostatin analogue treatment, and medical therapy for acromegaly, if needed. A 53 year-old female had an ocular lesion noted on a routine optician visit, originally considered to be an ocular melanoma. She had a bronchial carcinoid successfully removed 22 years previously. She had acromegalic features with an enlarged pituitary gland on magnetic resonance imaging and, additionally, metastatic lesions in her bones, liver, and thyroid gland. Elevated GHRH levels (&amp;gt;250\u00d7 upper limit of normal) suggested a metastatic lung neuroendocrine tumor secreting GHRH. Cold and radioactive somatostatin analogue therapy reduced both GHRH and insulin-like growth factor 1 (IGF-1) levels, but normalization of the biochemical markers of acromegaly was only achieved after pegvisomant was introduced. Complete control of IGF-1 was achieved, and this may have hindered the growth of the metastatic lesions as well, as the patient remains well 13 years after the diagnosis of metastatic disease and 35 years after the original lung operation. A gradual rise in prolactin levels over last 4 years was noted, which is likely due to the prolonged effect of GHRH on prolactin-secreting cells. The diagnosis of this case applied the law of parsimony from the Ockham\u2019s razor principle. We consider that breaking the vicious circle of IGF-1 feeding the metastatic tumor was key for the long-term outcome of this case.<\/jats:p>","DOI":"10.1210\/jendso\/bvac083","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T12:19:40Z","timestamp":1654258780000},"source":"Crossref","is-referenced-by-count":6,"title":["Ockham\u2019s Razor for a Retinal Lesion and Acromegaly and Breaking the Vicious Circle"],"prefix":"10.1210","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0289-7136","authenticated-orcid":false,"given":"Beata","family":"Rak-Makowska","sequence":"first","affiliation":[{"name":"Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London , UK"},{"name":"Medical University of Warsaw, Department of Internal Medicine and Endocrinology , Warsaw , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4223-9736","authenticated-orcid":false,"given":"Bernard","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Division of Medicine, University College London, Royal Free Hospital , London , UK"},{"name":"NET Unit, ENETS Centre of Excellence, Royal Free Hospital , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2800-7365","authenticated-orcid":false,"given":"Piya","family":"Sen Gupta","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London , UK"},{"name":"Department of Diabetes and Endocrinology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P Nicholas","family":"Plowman","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy\/Clinical Oncology, St. Bartholomew\u2019s Hospital , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1176-6186","authenticated-orcid":false,"given":"Ashley B","family":"Grossman","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London , UK"},{"name":"NET Unit, ENETS Centre of Excellence, Royal Free Hospital , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4101-9432","authenticated-orcid":false,"given":"M\u00e1rta","family":"Korbonits","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University 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