You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
acromegaly is a systemic , chronic , and slowly progressing condition resulting from excess growth hormone ( gh ) and insulin - like growth factor 1 ( igf-1 ) .
patients with acromegaly have a 1.6- to 3.3-fold increase in age - related mortality and a 10-year reduction in life expectancy , and cancer is the third most common cause of mortality .
the role of the gh - igf-1 axis in the development of malignancy has been continuously investigated , and igf-1 is thought to enhance cell proliferation and to inhibit apoptosis .
breast cancer is epidemiologically linked to igf-1 levels in premenopausal women , and an increased igf-1 level may increase the relative risk of developing colon cancer .
multiple myeloma ( mm ) is a malignant proliferative disease of monoclonal plasma cells that produce monoclonal immunoglobulins .
diagnosis of mm is made based on the clonal plasmacytosis of at least 15% on bone marrow examination or biopsy - proven clonal plasmacytoma , the presence of m protein in serum or urine , and any evidence of end - organ damage ( i.e. , hypercalcemia , renal insufficiency , anemia , and bone disease ) attributable to myeloma involvement .
although acromegaly is associated with malignancy , its association with mm has not been thoroughly investigated .
earlier reports demonstrated the role of gh and igf-1 in b lymphocyte activation   and the universal expression of igf-1 receptors in mm cells in vitro .
also , in several cases , acromegaly was associated with the malignant transformation of monoclonal gammopathy of undetermined significance ( mgus ) into overt mm . however , only a few actual cases of mm associated with acromegaly have been reported .
here we describe the first asian patient , who was diagnosed with acromegaly and mm , simultaneously .
a 58-year - old woman was admitted to our department for diagnostic workup of acromegalic features .
she had noticed the enlargement of her face , hands , and feet 8 years prior to her visit , and these were associated with hyperhidrosis , a thicker and deeper voice , and decreased libido . at that time , she had also undergone uvulectomy because of obstructive sleep apnea that had caused severe snoring .
she had a heart rate of 86 per minute , a respiratory rate of 20 per minute , and a body temperature of 36.5. during physical examination , the facial enlargement with frontal bossing was noticed , as was the disproportionate enlargement of the tongue , nose , lips , hands , and feet ( fig .
the serum protein level was 10.5 g / dl ( reference range , 6 to 8) and the serum albumin level was 2.5 g / dl ( reference range , 3.5 to 5.2 ) , reflecting a reversed albumin / globulin ( a / g ) ratio .
serum creatinine and calcium levels were 0.63 mg / dl ( reference range , 0.70 to 1.40 ) and 8.6 mg / dl ( reference range , 8.6 to 10.2 ) , respectively .
the fasting plasma glucose level was 109 mg / dl and the 2-hour postprandial plasma glucose level was 280 mg / dl .
hemoglobin a1c was 7.8% and the c - peptide level was 4.8 ng / ml . the thyroid - stimulating hormone level was 1.5 u / ml ( reference range , 0.4 to 5.0 ) and the free thyroxine level was 1.3 ng / dl .
basal levels of adrenocorticotropic hormone , prolactin , luteinizing hormone , follicle - stimulating hormone , and estradiol were 23.0 pg / ml , 6.8 ng / ml , 17.1 miu / ml , 44.4 miu / ml , and 10.0 pg / ml , respectively , which were all within normal ranges . serum levels of igf-1 and human growth hormone ( hgh ) were elevated to 898 ng / ml ( age - adjusted reference range , 71 to 284 ) and 42 ng / ml ( reference range , < 16.0 ) , respectively ( tables 1 , 2 ) .
because these laboratory findings strongly suggested acromegaly and associated diabetes mellitus , we performed a 75 g oral glucose tolerance test ( ogtt ) to confirm gh hypersecretion ( table 2 ) . to confirm the presence of a gh - secreting pituitary adenoma , we performed magnetic resonance imaging of the sella turcica .
it revealed a 1.00.6-cm pituitary adenoma on the left side of the pituitary gland ( fig .
2 ) . the markedly reversed a / g ratio and anemia led us to suspect a monoclonal gammopathy such as mm .
3 ) . protein electrophoresis ( pep ) and immunofixation electrophoresis ( ife ) of serum samples revealed a monoclonal gammopathy ( m peak 4.9 g / dl ) of immunoglobulin g ( igg)- type ; pep and ife of urine samples were inadequate because of low urinary protein .
the patient 's serum igg level was elevated to 5,860.0 mg / dl , and the  and lambda free light chain ratios were 7.16 and 34.50 mg / l , respectively . to confirm the diagnosis of mm , we performed bone marrow aspiration and biopsy with plasma cell phenotyping .
4a , b ) , and packed bone marrow with neoplastic plasma cells ( 35.6% of the clonal plasma cells ) was observed in the bone marrow biopsy specimen ( fig .
4c - f ) . in an attempt to find myeloma - related organ damage , we took simple x - rays of the entire body , and they did not reveal any osteolytic lesions . according to the diagnostic criteria for symptomatic mm
, one should exhibit more than one of the parameters reflecting myeloma - related organ dysfunction ( table 3 ) .
because the m peak was > 3 g / dl and the proportion of monoclonal plasma cells in the bone marrow was > 10% without myeloma - related orgam damages , the patient was diagnosed with asymptomatic ( smoldering ) mm .
however , it is of note that her serum hemoglobin level was at the cutoff value for diagnosis of symptomatic mm and that her serum calcium level was slightly below the cutoff ( table 3 ) . in accordance with the treatment guidelines for asymptomatic mm , we planned close follow - up , with deferral of chemotherapy until the disease became symptomatic . to treat the gh - secreting pituitary adenoma , the patient underwent tumor resection via a transsphenoidal approach . there were no immediate postoperative complications .
three days after surgery , the serum igf-1 level was measured and the 75 g ogtt was repeated .
although the serum hgh level was lower than it had been before surgery , the results indicated incomplete remission immediately after surgery ( table 2 ) .
however , after the surgery , the patient exhibited clinical improvements in acromegalic features , such as decreased skin thickness and reduced size of the extremities .
therefore , we decided to closely monitor the clinical and biochemical responses to the removal of the gh - secreting pituitary adenoma and to continuously determine the need for further treatment .
acromegaly is an uncommon endocrinologic disorder caused by overproduction of gh , most commonly by a gh - secreting pituitary adenomas .
earlier epidemiological studies have indicated a possible increase in malignancy risk in patients with acromegaly because gh and igf - i may promote proliferation and inhibit apoptosis of neoplastic cells . nabarro   found a markedly increased incidence of breast cancer in patients with acromegaly .
also , a large retrospective cohort study conducted by orme et al .   to determine mortality and cancer incidence in 1,362 subjects with
acromegaly reported a significant increase in the colon cancer mortality rate and a nonsignificant increase in mortality due to breast cancer .
the authors also found that mortality due to all malignant disease and colon cancer increased with higher posttreatment gh levels , which suggests that gh hypersecretion may have modified the progression of coexisting malignancies , particularly colonic carcinomas .
there have been sporadic case reports of hematologic malignancies such as lymphoma and leukemia associated with acromegaly .
however , the causal relationship between acromegaly and mm has not been clearly proven in clinical settings . despite the complexity of the interactions between the bone marrow microenvironment and surrounding stromal cells
, attempts have been made to determine the exact mechanisms of gh and igf-1 in the development and proliferation of myeloma .
murphy et al .   demonstrated that treatment with hgh had stimulatory effects on b - cell proliferation .
demonstrated the universal expression of igf-1 receptors in mm cells and postulated that igf-1 might act like a growth factor in human mm .
also , ge and rudikoff   demonstrated a stimulatory effect of igf-1 on six of eight myeloma cell lines , one of two b lymphoma cell lines , and neither of two t leukemia cell lines , where all cell lines expressed similar levels of igf-1 receptors .
the authors suggested that the igf-1 pathway is biologically relevant in the later stages of b - cell development .
there is neither an established therapeutic guideline nor a prognosis specific for acromegaly with mm .
however , several cases illustrate that treatment of acromegaly improves the progression of mgus or mm .
kanazawa et al .   reported a case of mgus in a patient with acromegaly in which the serum igg level , as well as the gh and igf-1 levels , decreased after the removal of the gh - secreting pituitary adenoma .
moreover , tucci et al .   described a patient with acromegaly in whom a longstanding mgus had transformed into overt mm . in this patient
, serum and urine m components indicated that mm activity was correlated with serum igf-1 levels .
these findings are solid evidence supporting the hypothesis that elevated gh and igf-1 levels promote the proliferation of malignant plasma cells in mm and that maintaining low levels of gh and igf-1 through intensive treatment might be a key therapeutic approach in treating coexistent mm . in our case ,
the patient 's serum hemoglobin level ( 10.0 g / dl ) was at the cutoff level for symptomatic mm and her serum calcium level ( 9.2 mg / dl ) was slightly below the cutoff , suggesting that the risk of transformation into symptomatic mm would have been very high had the acromegaly been left untreated .
follow - up measurement of serum and urine m proteins and simultaneous measurement of serum gh levels would be necessary to determine the long - term effect of the removal of the gh - secreting tumor on mm . although these measurements were unavailable in our study because of the recent diagnosis
, we expect a favorable prognosis because of the prompt surgical treatment of the acromegaly before the mm became symptomatic .
likewise , the lack of long - term follow - up data from previously reported cases makes it difficult to predict the prognosis of acromegaly with mm .
further long - term observational studies with a larger data set will allow us to specifically suggest appropriate therapeutic guidelines and to extrapolate the prognosis in patients with acromegaly and mm . in summary
our case strengthens the hypothesis of prior studies that acromegaly plays a significant role in the development of mm . considering previous studies that have demonstrated the role of igf-1 in plasma cell proliferation and the correlation between serum igf-1 levels and the progression of monoclonal gammopathy , prompt efforts to lower circulating gh and igf-1 levels are an important therapeutic approach .
further research with a larger set of longer term data is needed to develop treatment guidelines specific for mm accompanying acromegaly and to predict prognosis .
acromegaly is a slowly progressing condition resulting from excess growth hormone ( gh ) , generally caused by a gh - secreting pituitary adenoma . 
 cancer is the third most common cause of mortality in patients with acromegaly , and insulin - like growth factor 1 ( igf-1 ) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis . 
 multiple myeloma ( mm ) is a plasma cell neoplasm , and previous studies have suggested the possible role of igf-1 in its development of mm . 
 however , no cases of acromegaly accompanied with mm have been reported in asia to date . 
 we here report the case of a 58-year - old woman with acromegaly accompanied with mm who presented with longstanding acromegalic manifestations resulting from a gh - secreting pituitary adenoma and also exhibited anemia , a reversed albumin / globulin ratio , and plasmacytosis on bone marrow examination . because igf-1 has been suggested to play an important role in the development and progression of mm , the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach . since there is currently no consensus on therapeutic guidelines and suggested prognosis for mm with acromegaly , long - term follow - up of such cases 
 is needed .