Endocrine Abstracts

Introduction: Acromegaly is characterized by a pituitary adenoma with excess secretion of GH and IGF-1 hormones. More than 90% of the cases are diagnosed as macroadenomas, after 5 to 10 years of clinical manifestation.

Case report: We present the case of a 49 years old man with minor thalassemia, hospitalized in endocrinology department for a routine check of chronic autoimmune thyroiditis. A careful anamnesis showed that in the last year the patient was dizzy, the ring was not fitting on his finger and the shoes were tight. Laboratory findings: elevated IGF1 (617 ng/ml, normal range: 67–225 ng/ml), lack of GH suppression with oral glucose tolerance test (GH = 6.332 ng/ml, normal less than 1 ng/ml), HbA1c = 6.1% (4.8–5.7). MRI of the pituitary gland showed a 7.3 × 5 mm pituitary adenoma. Pituitary-gonadal axis was not affected nor optic chiasm. A thyroid ultrasonography was performed and a 1.48/1.01/1.29 cm nodule was discovered in the left lobe. The thyroid function was in normal range without medication, except thyroid peroxidase antibodies which were elevated. The patient underwent transsphenoidal adenomectomy with good result after surgery (IGF-1 = 259.50 ng/ml –postoperative and 3 months after surgery IGF-1 = 180 ng/ml with GH suppression with oral glucose tolerance test). The diagnosis of acromegaly was also confirmed histopathological. A fine needle aspiration biopsy of the thyroid nodule was performed and it was classified as Bethesda III. Also, the patient underwent screening for cardiomegaly, colon cancer, diabetes and sleep apnea and all were negative.

Conclusion: Diagnosis of GH-secreting pituitary adenoma as microadenomas increases the chance to cure the disease and improves the quality of life. In addition, patients do not develop other complications associated with excess of growth hormone. Early diagnosis is the key in the treatment of acromegaly.