Endocrine Abstracts

Background: Acromegaly is a rare disease characterised by an excessive production of growth hormone (GH), from a pituitary adenoma. It is a curable disease, either by surgery or by medical treatment, but very rare it can spontaneously cure by the apoplexy of the pituitary adenoma.

Case presentation: We present the case of a 58-year-old female who was suspected of acromegaly due to her physical appearance: soft tissue swelling and enlargement of the extremities, increase in shoe size, coarsening of facial features, prognathism, macroglossia, frontal bossing and cutis verticis gyrata. The patient complained of visual field defects and headaches, but she never claimed a clinical episode suggestive of pituitary apoplexy. She also presented some of the most frequent complications of acromegaly: high blood pressure, type 2 diabetes mellitus, sleep apnoea syndrome and benign colon polyps. The hormonal dosing revealed a normal insulin like growth factor 1 (IGF1) value of 72.08 ng/ml (normal range: 46–238), with a mean GH/24 hours of 0.2 ng/ml. Hormone studies on thyrotrophyc, corticotrophyc, gonadotrophyc and lactotrophyc lines were normal. Magnetic resonance imaging revealed the pituitary gland reduced in dimensions, plated by the sellar floor, with a pseudo-empty sella aspect, without the traction of the optic chiasm. Visual field examination revealed bilateral concentric shrinking. Lateral radiograph of the skull revealed thickened skull vault, pneumosinus dilation and prognathism, and AP radiograph of the hand showed ungal tufting.

Conclusions: In summary, we report a very rare case of acromegaly, which cured spontaneously by the apoplexy of the pituitary tumor.