Endocrine Abstracts

Introduction: Acromegaloidism is characterized by features of acromegaly without excessive GH secretion.

Case report: A 24-year-old male presented with acral enlargement and bilateral non-inflammatory wrist and ankle pain. He had coarse facial features, prominent clubbing, enlarged hands and feet. BMI was 21.3 kg/m². He did not have a relevant personal and family history. He was not on any medication. Due to his acromegaloid appearance he was referred to endocrinology out-patient clinic with the diagnosis of acromegaly. Basal GH level was 0.6 ng/ml and IGF1 level was 161 ng/ml (N: 115–358 ng/ml). Other anterior pituitary hormone levels and routine biochemical evaluation did not reveal an abnormality other than a slightly increased CRP level (41 mg/l). Fasting glucose level was 99 mg/dl, HOMA-IR was 1.1. RF and anti-CCP was negative. ALP level was within normal limits (93 U/l). Plain films revealed bony changes and the nuclear medicine whole-body bone scan showed bilateral increased tracer uptake in forearms and lower legs. Remaining bones had normal skeletal tracer distribution. The X-ray and scintigraphy results were consistent with hypertrophic osteoarthropathy. Further evaluation did not reveal a secondary cause so he was diagnosed with primary hypertrophic osteoarthropathy. For follow-up he was referred to the rheumatology out-patient clinic where he lived. Treatment with nonsteroidal antiinflammatories provided significant relief of pain.

Conclusion: Presence of acromegaly features without associated biochemical findings may be misinterpreted as mild-early acromegaly or so-called ‘burned-out’ acromegaly. Clinicians should also keep in mind the phenomenon ‘acromegaloidism’, although it is a rare condition. An extensive evaluation should be conducted to determine the underlying condition.