Endocrine Abstracts

The history of a female patient is demonstrated as an example of diagnostic and therapeutical pitfalls in acromegaly. The patient was first operated on a pituitary macroadenoma at her age of 21. Prior to surgery, serum prolactin was found moderately elevated and the patient was raromenorrhoic, without galactorrhea. Soon recurrence of the tumour was trialed with bromocriptine medication, however, without any inhibitory effect on the process. The patient underwent a second neurosurgery at the age of 26. Serum prolactin was found normal without bromocriptine thereafter. Her primary sterility was treated with FSH and hCG injections resulting in a healthy trigeminal pregancy. After these preceding events, she first visited the present authors with amenorrhea and unequivocal signs of acromegaly. Diurnal variation of serum hGH and OGTT proved a GH-excess. Chronic administration of somatostatin octreotid LAR was ineffective. A third surgical intervention was performed on the re-recurred macroadenoma at the age of 30. Hormonal supression with lanreotide was not successful either. Further growing of the tumoral remnant was tried to be influenced by gamma knife at the age of 34 followed by pegvisomant administration in order to blunt the clinical effect of the still existing GH excess and in the hope of a GH-decrease as aimed consequence of the latter irradiation therapy. One year after irradiaton and pegvisomant administration, the IGF1 level was in the normal range, and the tumour remnant showed some regression. While continuing the pegvisomant treatment and after more then a decade amenorrhea, the patient conceived. Then, we stopped the pegvisomant administration; during pregnancy no tumour growing was detected with MRI, and the patient gave birth to a healthy boy. An update therapeutical regime may involve neurosurgery, dopamin agonists, somatostatin analogs, irradiation and GH-receptor antagonist alike; an individualized therapy may be sometimes be astonishingly complex.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.