REPLY
Polycythemia Vera in Acromegaly
Pascale Grellier, MD;
Philippe Chanson, MD; and
Gilbert Schaison, MD
1 January 1997 | Volume 126 Issue 1 | Page 87
IN RESPONSE:
Teramoto and Ouchi point out that the complete remission of polycythemia vera that we saw in a patient after the surgical cure of acromegaly could have been partly caused by remission of hypoxemia in relation to obstructive sleep apnea. Obstructive sleep apnea, which is a common complication of acromegaly, can lead to polycythemia through the hypoxemia it produces. However, some of our patient's findings led us to believe that hypoxemia was not involved in the pathogenesis of polycythemia.
Even if the erythropoietin level is not specific for diagnosing polycythemia vera [1], polycythemia secondary to hypoxemia is usually associated with increased or normal erythropoietin levels. The erythropoietin levels of our patient were far below the normal range (<2 U/L; normal, 4 to 25 U/L). Moreover, there was a spontaneous growth of erythroid progenitors, which is considered to be specific for polycythemia vera and does not occur in cases of secondary polycythemia [2, 3]. Finally, we investigated sleep apnea before and after surgery. The patient had moderate obstructive sleep apnea that was not responsible for hypoxemia, as indicated in our original report. Although polycythemia disappeared after surgery, the obstructive sleep apnea and the oxyhemoglobin saturation had not changed in more than a year after the remission of acromegaly. These data provided sufficient evidence to rule out obstructive sleep apnea as a cause of polycythemia in our patient.
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Author and Article Information
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Hopital Bicetre; 94275 Kremlin-Bicetre, France
1. Casadevall N, Lacombe C, Varet B. Erythroid cultures and erythropoietin assay. Clinical and diagnosis value. Nouv Rev Fr Hematol. 1990; 32:77.
2. Lacombe C, Casadevall N, Varet B. Polycythemia vera: in vitro studies of circulating erythroid progenitors. Br J Haematol. 1980; 44:189-99.
3. Partanen S. Spontaneous erythroid colony formation in erythrocytocis. Scand J Haematol. 1982; 29:319-24.
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