Endocrine Abstracts

Introduction: Chronic somatotropin (ST) hypersecretion has systemic effects. It can cause important structural and functional cardiovascular (CV) changes, which can result in increased morbidity and mortality.

Case report: A 48-year-old, male. followed by cardiology since 2005 for dilated cardiomyopathy (DCM) (Ecocardiography: moderately dilated left ventricle with globular appearance. Severely impaired global systolic function - LVEF 25%. Right cavities not dilated. Slight thickening of the interventricular septum. No morphologic valvular alterations) after detection of complete left bundle branch block (LBBB) on an ECG performed during preoperative evaluation for varicose vein surgery. Since that time, he also referred increased size of hands/feet and prominence of the forehead. In 2010, he was diagnosed acromegaly caused by a pituitary adenoma (Immunohistochemistry: ST expression and less of prolactin). It was performed transsphenoidal resection, but it wasn’t achieved biochemical control even with medical treatment. He also presented evidence of residual disease on pituitary magnetic resonance, motivating a second surgery in 2012. Then he restarted octreotide LAR with biochemical control. In the postoperative period, he presented epigastric discomfort associated with widespread changes on ECG ST segment. It was performed cardiac catheterization, but no significant obstructive lesions were found. He had already done a myocardial perfusion scintigraphy which was negative for ischemia. These two procedures allowed the exclusion of coronary arterial disease. He maintain follow-up with cardiology and at the evaluation in 2013 he presented an LVEF 20% with intra/interventricular asynchrony and a LBBB on ECG with QRS complex duration of 190 msec. Given this, a cardiac resynchronization device was implanted.

Discussion: Although rare, DCM is possible in the evolution of acromegaly. In some cases there may be improvement of cardiac dysfunction and structural changes with somatotropin normalization. However, in others cases specific treatments are needed to reduce the associated CV morbidity and mortality.