Endocrine Abstracts

Background: Acromegaly is a rare disorder, with a prevalence of 6 cases of 100000 and an annual incidence of 3–4 new cases of one million. It is almost always the consequence of GH secreting pituitary adenomas and, rarely, caused by nontumoral somatotrophic hyperplasia.

Case presentation: 54 years old patient, heavy smoker, hypertensive, dyslipidemic, obese, presents in June 2019 with unspecific symptoms: physical asthenia, hypersomnia (falls asleep during interview), dyspnea, disorientation and visual and auditive hallucinations, that aggravated progressively during the last 3 months. Clinically, the patient has a discrete acromegalic phenotype and hyperpigmentation of the skin. A cerebral IRM was performed that revealed a 2 cm pituitary macroadenoma. Laboratory findings show normal cortisol levels and adequate suppression after dexamethasone, normal prolactin and thyroid hormone levels, but an increased IGF1 and elevated levels of GH after standard testing of GH in OGTT. Also, the patient had severe respiratory insufficiency, for which was evaluated in a pneumonology department, taking into consideration the possibility of sleep apnea. After the correction of the respiratory failure, the patient’s hallucinations stopped and the breathing improved significantly.

Conclusions: The particularity of the case is that, based on the progressive hyperpigmentation of the skin, the metabolic and psychiatric disorders, the initial suspicion was of a Cushing’s disease, but that was not confirmed by laboratory investigation. More so, the psychiatric manifestations were related to the respiratory failure, and not to the disease itself.