Endocrine Abstracts

Acromegaly is a rare chronic disease due to sustained and unregulated hypersecretion of growth hormone that develops insidiously and progresses slowly. It may result in a variety of cardiovascular, respiratory, endocrine, metabolic, musculoskeletal, and neoplastic comorbidities. In more than 99% of cases this is due to a benign pituitary growth hormone secreting adenoma. Infrequently acromegaly occurs as a result of ectopic secretion of growth hormone releasing hormone from a peripheral neuroendocrine tumour. 5% of cases are associated with familial syndromes. It can remain undiagnosed for about 10 years with only 50% of patients with somatotroph adenomas revealing distinct phenotypic changes, whereas the other 50% are mostly asymptomatic. We present a case of a 34- year- old female who presented with chronic migraines. She had an MRI head that showed a left sided pituitary incidentaloma measuring 14 x5 x5mm. On endocrinology review, patient did not report any symptoms and there were no clinical manifestations of any hormone excess. Anterior pituitary profile showed a raised IGF-1(88.5 nmol/l) but the rest was normal. OGTT with serial growth hormone measurements also showed unsuppressed GH. This case was discussed in the pituitary MDT and it was decided that patient should have surgery, although there was no current clinical manifestation, but in view of insidious onset and impending manifestations. Transsphenoidal hypophysectomy was done in August 2024. Histology showed pit-1 strongly positive and GH present with 40% positivity, Ki67 3-4% in keeping with a somatotroph adenoma. Post operatively the headaches resolved, the IGF-1 normalised and OGTT showed suppressed growth hormone, and the AIP gene testing result is awaited.

Conclusion: Early diagnosis and adequate treatment are essential to mitigate excess mortality risk associated with acromegaly. Our case was picked up early due to the incidentaloma, timely referral to endocrinology and pituitary MDT which made early treatment possible.