Remission of Polycythemia Vera after Surgical Cure of Acromegaly

Polycythemia can be classified as a secondary or primary disorder. Increased erythropoietin levels associated with decreased oxygen saturation or with release by certain tumors cause secondary polycythemia. Polycythemia vera is a myeloproliferative disease characterized by abnormal clonal proliferation of an early hematopoietic progenitor, which leads to hyperplasia of all myeloid lineage cells [1]. Diagnostic criteria include increased erythrocyte mass associated with either splenomegaly or increased leukocyte and platelet counts. The precise cause of the marked erythroid expansion observed in patients with polycythemia vera has been debated. Recent studies [2-6] have suggested that insulin-like growth factor 1 (IGF-1) may play a role. We recently evaluated a patient who presented with both polycythemia (with in vitro features of polycythemia vera) and acromegaly. Treatment of acromegaly resulted in complete remission of hematologic abnormalities, suggesting a causal relation between growth hormone or IGF-1 and the development of polycythemia.