SFEBES2008 Poster Presentations Pituitary (62 abstracts)
Spontaneous recovery from severe cardiac failure after acute hypotensive infarction of a somatotroph adenoma
Carla Moran 1 , Colin Davenport 1 , Lucy Ann Behan 1 , Mohd Shazli Draman 1 , Thomas King 1 , Seamus Sreenan 2 , Christopher Thompson 1 & Amar Agha 1
1Beaumont Hospital, Dublin 9, Ireland; 2James Connoly Memorial Hospital, Blanchardstown, Dublin 15, Ireland.
Acromegalic congestive cardiac failure (CCF) is a serious and late complication of untreated acromegaly with associated high morbidity and mortality.1 Spontaneous recovery of end stage acromegalic CCF following autoinfarction of a somatotroph adenoma has not been previously reported.
We report the case of a 61-year-old woman who presented with features of severe biventricular CCF and an acromegalic phenotype. Echocardiography revealed poor LV function with an ejection fraction of 17%. Basal serum GH concentration was 71 ng/ml with a paradoxical rise following glucose challenge and she had markedly raised IGF-1 concentration. MR scan showed a suprasellar pituitary macroadenoma. She was initially treated with supportive therapy including diuretics, inotropes, anti-arrythmics, and insulin for hyperglycaemia. On day 8, she had a hypotensive episode of 16 h duration (BP 70/60 mmHg). Two days later, there was a marked improvement in her condition with resolution of her oedema and independence of inotropes and insulin. On day 12, mean GH concentration on a 5-point day curve was 1.56 ng/ml (safe level <2 ng/ml) and serum IGF-1 normalized to 153 ng/ml (normal 75–212). Repeat outpatient echocardiogram showed an ejection fraction of 50%. Repeat MRI showed an involuted, infarcted pituitary mass. Follow-up assessments continue to show safe GH and normal Serum IGF-1 concentrations.
This is the first case report of spontaneous recovery of severe acromegalic cardiomyopathy as a result of acute hypotensive infarction of the somatotroph adenoma. It can be said that a complication of acromegaly resulted in cure of the disease itself.
Reference
1. Orme SM, McNally RJQ, Cartwright RA, Belchetz PE 1998. Mortality and cancer incidence in acromegaly: a retrospective cohort study. J Clin Endo Metab 83 2730–2734.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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