A 35 year old lady presented to endocrine services with a background of attempted conception and oligomenorrhoea. Presenting features were typical of acromegaly including sweating, acne and median nerve entrapment. Growth hormone day curve showed unrelenting high levels of growth hormone. Serum IGF-1 was elevated at 154 nmol/l (normal 14.236.9). Other pituitary blood tests were within normal limits. A pituitary macroadenoma measuring 1.5×1.5×1.3 cm was found on MRI. There were no neuro-ophthalmic signs to suggest compression of the optic chiasm and the blood pressure was normal. The patient strongly desired future fertility and so a decision was taken to try and shrink down the pituitary tumour using somatostatin analogue therapy. It was hoped that this would better delineate the tumour from normal pituitary tissue, so that surgical resection might be less traumatic and would hopefully avoid damaging gonadotroph function. She underwent uncomplicated Transsphenoidal surgery in 2012. The operation note mentions that a tumour was visualised on the left hand side of the pituitary gland as seen on the pre-op MRI. Histology showed a pituitary adenoma with cells staining strongly for growth hormone. Ki 67=1%. Appearances were consistent with a densely granulated somatotroph adenoma. Soft tissue changes associated with acromegaly disappeared after the surgery and the patient was left with normal pituitary function the growth hormone level fell by 90% (compared to pre-op values). Normal menses returned and the patient subsequently had two successful pregnancies. Post-op MRI had shown a 6 mm area of tissue with reduced enhancement in the surgical bed which was thought to represent post-surgical change. Her serum IGF-1 remained mildly elevated (355 ng/ml, normal 109284) and latterly she was put onto cabergoline (which proved ineffective) and more recently back onto a small dose of somatostatin analogue to control residual, very mild, symptoms.
16 - 18 Apr 2018
Society for Endocrinology