Endocrine Abstracts

Introduction: Acromegaly is a chronic endocrine disorder caused by excess growth hormone (GH) secretion. Hypersecretion of GH causes increased IGF-1 secretion from the liver which in turn leads to a series of multisystemic complications including somatic overgrowth and multiple comorbidities.

Case report: Thirty-nine-year-old female patient was seen in ophthalmology outpatient clinic with the complaint of a mass inside the right upper eyelid. On ophthalmologic examination a 10x10 mm mass was noted inside the lateral part of the right upper eyelid and an orbital magnetic resonance imaging (MRI) was planned with a preliminary diagnosis of lacrimal gland cyst/tumor. MRI revealed a 16×8×10 mm pituitary mass expanding the sella, extending to the right cavernous sinus deviating infindibulum to the left. The patient was referred to the endocrinology outpatient clinic. On medical history her periods had stopped one month ago. When questioned she mentioned that she was snoring during sleep and her shoe size had increased from 38 to 39. On physical examination she had prognatism, deep nasolabial folds and a conjuctival mass inside right upper eyelid was noted. On laboratory evaluation, her IGF-1 level was 275 (normal range: 66–240) ng/ml. On 75 gram oral glucose load, fasting and 2-hour plasma glucose level was 97 and 126 mg/dl, respectively, while baseline and 2-hour serum GH level was 1.98 and 1.05 ng/ml, respectively. The patient had pituitary adenomectomy and immunohistochemical analysis of the pathology specimen was compatible with GH-secreting pituitary adenoma.

Conclusions: Hypersecretion of GH may cause somatic overgrowth and these patients may present with several different clinical or metabolic features. Regarding eye involvement in acromegaly there is a previous report of a patient with restrictive extraocular myopathy and another report with epiphora and proptosis. This is the first case report in English literature regarding lacrimal gland hypertrophy as a presenting complaint in acromegaly.