Endocrine Abstracts

Introduction: Acromegaly is a disease caused by excessive secretion of GH. The cause of acromegaly is GH secreting pituitary adenoam in 99% of the cases. It is estimated that 5% of pituitary adenomas become invasive and may grow to gigantic sizes (>4 cm in diameter). Here, we present a 31 years old acromegalic woman with a delayed diagnosis of a giant invasive pituiatary adenoma.

Case report: A 31-year-old woman admitted to our hospital for oligomenorhea and loss of vision. She had a history of infertility for 10 years. She received IVF five times. Her FSH was 0.43 (3.5–12.5) mU/ml, LH was 0.07 (2.4–12.6) mU/ml, prolactin was 27 ng/ml (4.7–23) and IGF1 was 984 ng/ml (116–307 for her age). Her nadir GH level during a 75 g oral glucose tolerence test was 14.8 mg/dl. Pituitary magnetic resonance imaging revealed a 72×47×68 mm macroadenoma with necrotic componenets which invades suprasellar region and sphenoid sinus and destructs sphenoid bone. Despite a giant macroadenoma her thyrotrophes and corticotrophes were not affected. She had normal thyroid and adrenal fucntions. She had transcranial removal of the adenoma and histopathological diagnosis was eosinophilic somatotroph adenoma. Immunhistochemical staining was positive for GH. Postoperatively, she had severe hypernatremia and she was followed in intensive care unit. She died in her second postoperative day with severe electrolyte imbalance.

Conclusions: Delayed diagnosis of acromegaly may lead to growth of a giant macroadenoma which then increases the likelihood of morbidity, postoperative complications and mortality.