Endocrine Abstracts

JOINT3807

Introduction: Pituitary acrogigantism is a very rare endocrine disease that is caused by chronic growth hormone (GH) and its mediator, insulin-like growth factor 1 (IGF-1) axis excess, that begins during childhood and adolescence. As such, it represents one of the most severe manifestations of acromegaly. In most cases, acrogigantism is caused by a pituitary adenoma. The disease leads to numerous complications, including metabolic, cardiovascular, and oncological issues. Despite advances in diagnosis and treatment, delays in recognition remain a challenge. Treatment of pituitary acrogigantism involves a multimodal approach, combining surgical, pharmacological, and in some cases radiotherapy interventions. The use of somatostatin analogues first and second generation has significant role, especially in patients with incomplete tumor resection or persistently high levels of GH and IGF-1.

Case study: The study is based on the case analysis of a 21-year-old patient, diagnosed with pituitary acrogigantism due to a pituitary macroadenoma. A pituitary tumor was revealed during the diagnosis of chronic otitis. Diagnostics included laboratory tests (levels of GH in OGTT oral glucose tolerance test, IGF-1) and imaging studies (pituitary MRI, thyroid and abdominal ultrasound, echocardiography). Treatment involved surgical intervention (endoscopic tumor resection), pharmacological therapy (lanreotide) and monitoring of therapy progress. After tumor resection, partial normalization of GH and IGF-1 levels was achieved; however, symptoms of active acromegaly persisted. Lanreotide treatment was initiated, leading to further improvement in hormonal parameters and the patient’s well-being. Nevertheless, in the following months, recurring symptoms such as chronic fatigue, excessive sweating, and joint pain were observed. A second generation analogue -pasireotide were used, resulting in normalization of IGF1 and good disease control. Actually patient is a is a first-year medical student.

Conclusions: Patients with pituitary acrogigantism have a heavy burden of disease and a complex treatment journey. Rapid implementation of surgical and pharmacological treatment is crucial. The use of somatostatin analogues is effective in controlling GH and IGF-1 levels in patients with residual disease activity. A second generation somatostatin analogues are perspectives for patients with hard-to-control acromegaly.