Endocrine Abstracts

JOINT2707

Introduction: Acromegaly is a neuroendocrine disorder characterized by excessive growth hormone (GH) secretion, which exerts anabolic effects on various organs and tissues. Through direct action or indirectly via insulin-like growth factor-1 (IGF-1), GH can contribute to endothelial dysfunction, which is closely linked to cardiovascular complications, including cardiac pathology.

Clinical Case: A 54-year-old patient with acromegaly, who had undergone transnasal transsphenoidal pituitary adenoma resection on October 2019, was admitted to the Endocrinology Research Centre for remission assessment. Notably, two months prior to hospitalization, the patient was diagnosed with infectious spondylodiscitis of unspecified etiology, presenting with persistent fever and back pain. Spinal MRI confirmed spondylodiscitis at the Th6-7, Th9-11, and L3-5 levels. Despite antibacterial therapy, fever persisted. Rheumatological evaluation ruled out HLA-B27-associated spondylodiscitis, and NSAID therapy yielded no improvement. In the neuroendocrinology department, laboratory tests revealed elevated inflammatory markers: ESR 62 mm/h, ferritin 316.1 ng/ml, and CRP 272 mg/l, while procalcitonin remained within normal limits. Given the suspicion of hematogenous infection, transthoracic echocardiography suggested vegetations on the anterior mitral valve leaflet. Transesophageal echocardiography confirmed the presence of vegetations and severe mitral regurgitation. Blood cultures identified Enterococcus faecalis, and targeted antibiotic therapy with linezolid was initiated for two months, resulting in clinical improvement and subsequent mitral valve replacement. To assess acromegaly activity, IGF-1 levels were measured at 179.2 ng/ml (reference range: 104–230), while GH was slightly elevated at 6.79 ng/ml (0.4–3.6). However, the presence of an active infection complicated result interpretation. An oral glucose tolerance test (OGTT) for GH suppression was deemed unreliable due to the high likelihood of false-positive results. Brain MRI with contrast enhancement revealed residual adenomatous tissue, no ophthalmological signs of optic-chiasmal syndrome were noted at perimetry. Upon resolution of the inflammatory process, IGF-1 levels increased to 276 ng/ml, with persistent GH elevation and lack of suppression during OGTT. Consequently, octreotide therapy was initiated.

Conclusions: Acute inflammatory processes can significantly impact the interpretation of biochemical markers in acromegaly. Therefore, dynamic monitoring is essential to ensure accurate assessment and timely treatment adjustments.