Introduction: Cardiovascular disease is present in up to 60% of patients diagnosed of acromegaly and is responsible of the major related morbidity and mortality.
Case report: A 79-year-old-woman with previous history of diabetes mellitus and hypertension was admitted for acute pulmonary edema. Transthoracic echocardiogram showed a severe left ventricular dysfunction with an ejection fraction of 20%, dilated left ventricle and left atrium with a moderate mitral regurgitation. On physical examination, she had rough features, with growth of acral parts, prognatism, macroglossia, diastema, acrochordons and goiter, suggestive of acromegaly, without any previous study. During the admission, she suffered a sudden episode of severe frontal headache with hypotension and hyponatremia. Pituitary apoplexy and acute secondary adrenal insufficiency was suspected and immediate treatment with intravenous steroids was initiated. MRI showed a heterogeneous intrasellar mass of 2.3×2.3 cm with hemorrhagic component secondary to necrosis. Hormonal analysis revealed a hypogonadotropic hypogonadism, secondary adrenal insufficiency, suppressed TSH, normal FT4 and low FT3. Serum levels of GH and IGF1 were within normal limits. Visual field was not valuable. She was discharged with the diagnosis of acromegaliccardiomyopathy.
Eight months later, she presents an improvement of her acromegalic features, with hypogonadotropic hypogonadism, secondary adrenal insufficiency and normal GH and IGF1 serum levels. The echocardiogram shows an improvement of the left ventricular volume and the systolic left ventricular function with an ejection fraction of 50% and mild mitral regurgitation.
Conclusions: An early and accurate diagnosis of acromegaly is important to prevent serious cardiac related complications.
Acromegalic cardiomyopathy may improve dramatically with the treatment of the disease or exceptionally following a pituitary apoplexy, as illustrated in this case.
30 Apr - 04 May 2011
European Society of Endocrinology