Pseudoacromegaly is associated with acromegalic phenotype but normal insulin like growth factor-1 (IGF-1) levels and suppressed growth hormone levels. The reasons of this condition may be pachydermoperiostitis insulin resistance, drug intake such as minoxidil and hypothyroidism (4). We describe pachydermoperiostitis in a patient with hyperthyroidism and non-secretory pituitary macroadenomas.
Clinical case: A 62 year old man presented with palpitation, sweating and weight loss. Physical examination revealed thats multi nodular goitre, acral enlargement, gigantism, fall in the left eye lid and thickening of the skin (heel-pad thickness was 27 mm on right foot and 28 mm on left foot) Laboraory results revealed that serum st4 37.7 pmol/l (12.8<n<20,4), TSH <0.006 μIU/ml (0.47<n<4.2), IGF-1 91.8 ng/ml (75(n(212). We re-evaluated GH-IGF-1 levels after treatment of hyperthyroidism. After being euthyroid, GH level 0.379 ng/ml (1<n<9), IGF-1 88 ng/ml (75<n<212). GH level was suppressed after 100 gr oral glucose load. Pituitary magnetic resonance imaging revealed 10.5 mm macroadenoma. All pituitary hormone levels of patient was normal. Advanced investigation for hyperinsulinemia, hypothyroidism and drug use revealed nothing. In contrast patient has hyperthyroidism. Two sons of the patients physical exam revealed acral enlargement, gigantism and thickening of the skin as a patient. GH levels, IGF-1 levels and pituitary MRI of the sons of patient was normal. We considered patient and two sons have autosomal dominant inheritance pachydermoperiostitis.
Conclusion: This is a very rare case of pseudacromegaly due to pachydermoperiostitis with nonfunctioning pituitary adenoma in patient with toxic multinodular goitre.
20 - 23 May 2017
European Society of Endocrinology