Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2008) 15 P230

SFEBES2008 Poster Presentations Pituitary (62 abstracts)

Spontaneous recovery from severe cardiac failure after acute hypotensive infarction of a somatotroph adenoma

Carla Moran 1 , Colin Davenport 1 , Lucy Ann Behan 1 , Mohd Shazli Draman 1 , Thomas King 1 , Seamus Sreenan 2 , Christopher Thompson 1 & Amar Agha 1


1Beaumont Hospital, Dublin 9, Ireland; 2James Connoly Memorial Hospital, Blanchardstown, Dublin 15, Ireland.


Acromegalic congestive cardiac failure (CCF) is a serious and late complication of untreated acromegaly with associated high morbidity and mortality.1 Spontaneous recovery of end stage acromegalic CCF following autoinfarction of a somatotroph adenoma has not been previously reported.

We report the case of a 61-year-old woman who presented with features of severe biventricular CCF and an acromegalic phenotype. Echocardiography revealed poor LV function with an ejection fraction of 17%. Basal serum GH concentration was 71 ng/ml with a paradoxical rise following glucose challenge and she had markedly raised IGF-1 concentration. MR scan showed a suprasellar pituitary macroadenoma. She was initially treated with supportive therapy including diuretics, inotropes, anti-arrythmics, and insulin for hyperglycaemia. On day 8, she had a hypotensive episode of 16 h duration (BP 70/60 mmHg). Two days later, there was a marked improvement in her condition with resolution of her oedema and independence of inotropes and insulin. On day 12, mean GH concentration on a 5-point day curve was 1.56 ng/ml (safe level <2 ng/ml) and serum IGF-1 normalized to 153 ng/ml (normal 75–212). Repeat outpatient echocardiogram showed an ejection fraction of 50%. Repeat MRI showed an involuted, infarcted pituitary mass. Follow-up assessments continue to show safe GH and normal Serum IGF-1 concentrations.

This is the first case report of spontaneous recovery of severe acromegalic cardiomyopathy as a result of acute hypotensive infarction of the somatotroph adenoma. It can be said that a complication of acromegaly resulted in cure of the disease itself.

Reference

1. Orme SM, McNally RJQ, Cartwright RA, Belchetz PE 1998. Mortality and cancer incidence in acromegaly: a retrospective cohort study. J Clin Endo Metab 83 2730–2734.

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