Endocrine Abstracts

Background and aim: Acromegaly is mostly due to a somatotropic adenoma. Regarding its insidious nature, this adenoma is often revealed at an invasive stage when one or more hormonal insufficiencies are already installed. This study aims to describe the clinical and biological features of hypopituitarism associated with somatotropic adenomas.

Patients and Methods : We conducted a retrospective study at the Endocrinology department of Hedi Chaker University Hospital, Sfax, Tunisia. We involved 29 patients diagnosed with acromegaly, whose clinical, biochemical, and imaging peculiarities were collected from medical charts.

Results : The mean age at diagnosis was 45.8±12.4 years with a male predominance (51.7%). The mean duration of symptoms was 5.1±5.4 years. Pituitary tumor syndrome (30%) and acrofacial dysmorphia (16.6%) were the main reasons for consultation. Signs of hypocortisolism were reported by 34.5% of patients, notably asthenia (n=9) or weight loss (n=2). Corticotropic insufficiency was biologically confirmed in 16.6% cases. Hypogonadism was clinically observed in 26.6%. Erectile dysfunction (n=4), secondary amenorrhea (n=3) and primary infertility (n=1) were the revealing circumstances. Biological exploration of the gonadotropic axis confirmed its insufficiency in 33.3%. Clinical hypothyroidism affected 13.8% of patients, with psychomotor slowing in the foreground (n=4). Thyroid insufficiency was found in 16.6% of cases. In our cohort, the hypopituitarism was dissociated in 40%, with a remarkable predominance of the co-occurrence of gonadotropic and thyroid insufficiency (n=3). Panhypopituitarism was noted in only one case.

Discussion: Various degrees of hypopituitarism may be present at the time of diagnosis of a GH adenoma, affecting up to ¾ of patients. The potential mechanism would be pituitary cell compression or destruction or even hemorrhagic necrosis. The gonadotropic sector is the first to be affected. The corticotropic and thyroid deficits seem to be delayed and more partial.