Acromegaly Presenting With Bilateral Vocal Fold Immobility: Case Report and Review of the Literature

  • Timothy Cooper
    Affiliations
    Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
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  • Peter T. Dziegielewski
    Affiliations
    Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
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  • Praby Singh
    Affiliations
    Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
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  • Robert Seemann
    Correspondence
    Address correspondence and reprint requests to Robert Seemann, Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 216-11808 St. Albert Trail NW, Edmonton, AB, Canada T5L 4G4.
    Affiliations
    Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB, Canada T6G 2B7.
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Published:October 06, 2015DOI:https://doi.org/10.1016/j.jvoice.2015.09.008

      Summary

      Objective

      To present a case of bilateral vocal fold immobility (BVCI) in a patient with acromegaly and review the current literature describing this presentation.

      Design

      Case report and literature review.

      Setting

      Academic tertiary care center.

      Methods

      English language literature search of online journal databases.

      Results

      A 56-year-old man presented with 3 months of progressive stridor and shortness of breath. Transnasal flexible endoscopy revealed BVCI. A tracheostomy was performed to secure his airway. Further history was suggestive of acromegaly and imaging demonstrated a pituitary macroadenoma. The diagnosis of acromegaly was made. The patient was treated with octreotide followed by an endoscopic trans sphenoidal resection of the pituitary adenoma. Sixteen months after his initial presentation, a right laser arytenoidectomy was performed and the patient was subsequently decannulated. In the literature to date, 11 cases of BVCI in acromegaly have been reported. These patients often present with stridor and require a tracheostomy. With treatment of their acromegaly, these patients may regain vocal fold mobility and may be decannulated.

      Conclusion

      Acromegaly with BVCI is a rare presentation. Acute management of the airway of patients with acromegaly presenting with BVCI typically requires a tracheostomy. A period of 15 months should be allowed for restoration of vocal fold mobility before airway opening procedures are considered.

      Key Words

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