Hirsutism though common in women of reproductive age, is classically associated with polycystic ovarian syndrome (PCOS). It is rarely seen as a prominent feature of acromegaly because of its lack of specificity and occurrence. We report a case of 28-year-old female with 3 year duration of aligoamenorrhea and hirsutism. She was followed by a gynecologist who retains the diagnosis of polycystic ovary syndrome (PCOS). After 5 years the patient complaints of increased hand finger and shoes size. She was referred to endocrine department for suspicion of Acromegaly. Clinical examination revealed acromegaloidism features with mandibular prognathism and moderate macroglossia wic. Biological investigation were significant for elevated insulin-like growth factor 1 (IGF-1) level (774 ng/ml normal: 98290 ng/ml) and a growth hormone level not suppressed by a glucose challenge test. MRI brain revealed a pituitary macroadenoma (10.7×14 mm). The patient underwent an uncomplicated trans-sphenoidal resection of a pituitary macroadenoma. Immunohistochemistry demonstrated a GH tumor. The patient subsequently had normalization of growth hormone dynamics and regular menstrual cycles. Our case highlights the importance of a lookout for subtle features of acromegaly in patients with hirsuitism and going for hormonal investigation to make the diagnosis of acromegaly at an earlier stage of the disease.
18 - 21 May 2019
European Society of Endocrinology