A 22 year old man was referred to the endocrine unit at St Barts following an abnormal visual field test with his optician and subsequently with ophthalmology at Moorfields eye hospital. At presentation he was noted to be very tall (194 cm), with facial features of growth hormone excess. Despite starting puberty at the age of 1213 he had experienced continued vertical growth - he was the tallest in his family and his parents had commented that he was continuing to grow, even at the age of 22. He was also still outgrowing his clothes lengthwise year on year. Over the last 34 years he had experienced severe intermittent headaches, growth in his shoe size by 2 sizes and a growth in his hand size - he had been able to play the guitar 4 years ago and when he tried to start playing again recently he was unable to get his fingers between the guitar strings. He also reported a reduction in his libido. Significantly he had been for an opticians eye test 3 years ago due to headaches and visual field testing had been abandoned as he had found it difficult to see the object without shifting his gaze. Examination was remarkable for tall stature, the presence of mutiple skin tags, large doughy hands, a prominent brow and an enlarged nose. Testicular volume was 12 ml bilaterally but the testes were soft. IGF1 was raised at 1093 mcg/l (normal 113320), testosterone was low at 5.1 nmol/l (normal 8.629) with normal range LH and FSH. 9AM cortisol was 330 nmol/l ACTH 36 ng/l. OGTT was indicative of growth hormone excess. Formal Goldman perimetry demonstrated a bitemporal hemianopia. MRI pituitary showed a large pituitary macroadenoma with distortion of anterior visual pathways, but there was no extension into the cavernous sinuses. He has now started Lanreotide and an urgent referral for Transspheonidal surgery has been made to our local neurosurgical centre.
16 - 18 Apr 2018
Society for Endocrinology