Endocrine Abstracts

Introduction: More than 95% of cases of Acromegaly are caused by pituitary adenomas that present with insidious onset of symptoms due to local mass effects or due to excess of GH/IGF-1. It is often diagnosed late and results in high morbidity and mortality.

Case: We present a case of a woman in her fifties with atypical presentation of acromegaly with a left sided headache for 2 years with no associated visual symptoms and fatigue. She only had a past medical history of type 2 diabetes and hypertension. On examination, she had a short stature with normal facial features, no gross phenotypical abnormalities s and her visual fields on confrontation were unremarkable.

Investigations: MRI scan of the pituitary gland showed a 1cm enhancing nodule in the left lateral aspect of pituitary gland consistent with a pituitary adenoma. Her anterior pituitary screen were within normal range other than an isolated raised IGF-1 49.7 nmol/l which, along with the MRI findings, raised the suspicion of possible Acromegaly. He OGTT was diagnostic at 60 min non suppression of GH levels as well.

Management and Discussion: This patient was referred for trans sphenoidal surgery (TSS) under neurosurgery as her pituitary lesion was a surgical target. TSS has been the definite treatment of choice in this cohort of patients. We recognize that the mainstay of treatment for pituitary adenomas can be either pituitary surgery, medical therapy for residual disease or radiotherapy. All these decisions must be undertaken under an MDT setting to achieve better outcomes. This patient highlights the importance of exercising a high degree of suspicion for early detection of Acromegaly which can sometimes present with vague symptoms. Over all benefit would be better long term outcomes of this high risk group of patients with active disease.