Endocrine Abstracts

Introduction: Acromegaly is a rare endocrinopathy which shows characteristic phenotypic and metabolic features. Primarily patients in their forties or fifties suffer from this disorder but the main problem is late diagnosis, especially in men, even 10 years after the first symptoms. We present an unusual clinical course of acromegaly with no phenotypic features to stress the need to perform complete evaluation of endocrine function in hypogonadal patients.

Case report: A 24-year-old male was admitted to the Department of Endocrinology of the Medical University of Lublin in order to confirm the diagnosis of hypogonadism established in an outpatient clinic. The patient complained about low libido, erectile dysfunction, excessive sweating at night present for 8 months. The course of pubescence was normal. Physical examination showed normal genitalia, scraggly facial hair, normal inguinal and pubic hair. Hormonal tests of the hypothalamic–pituitary system showed hypogonadotrophic hypogonadism, hyperprolactinemia and surprising hypersomatotropism (IGF1: 814.3 ng/ml+GH: 25.10 ng/ml) which was confirmed in the OGTT (75 g): GH 0’: 21.3, 60′: 18.4 ng/ml. In the differential diagnosis the patient was preliminary diagnosed with acromegaly, which was confirmed with MRI that showed pituitary macroadenoma 30×35×20 mm in size, with sphenoid sinus and left cavernous sinus expansion and optic chiasm compression and modeling. The patient was qualified for transsphenoidal adenectomy preceded by 6 months of treatment with long-acting somatostatin analogue. The surgery was uncomplicated. The patient’s hormone levels returned to normal.

Conclusions: In differential diagnosis of hypogonadism growth hormone-secreting pituitary adenomas with abnormal clinical course should be considered.