Endocrine Abstracts

Acromegaly is a rare disease, which is mainly caused by benign tumour of the pituitary gland. Long-term presence of elevated growth hormone (GH) and insulin like growth factor 1 (IGF-1) levels accompanying this disease is associated with rheumatologic, cardiovascular, pulmonary and metabolic complications. Cardiovascular complications of acromegaly include a cardiomyopathy, arterial hypertension, arrhytmias, valvulopathy as well as endothelial dysfunction. Cardiovascular diseases are the leading cause of mortality in patients with acromegaly. We describe a 39-year-old male with undiagnosed acromegaly presented with acute heart failure caused by acromegalic cardiomyopathy. Pacient with 3 months history of artrerial hypertension was admitted to the department of internal medicine with orthopnea and pitting edema of the lower limbs experienced over a 1-month period. He also had excessive sweating over a 1 year. Physical examination on admission showed that his height and body weight were 193 cm and 150 kg. Blood pressure was 140/95 mmHg, and heart rate was 66/ min with sinus rhythm. He showed acromegalic features such as outstanding jaw and eyebrow area, enlarged hands, feet and also nose, tongue and lips. Pulmonary auscultation revealed coarse crackles in the bilateral lower lobes. Echocardiography showed dilated and hypertrophic left and right ventricles (IVS 17 mm), restrictive filling pattern, global hypokinesia, systolic dysfunction with EF 22% without valvulopathy. Comprehensive treatment of heart failure was initiated. To rule out coronary artery disease, a coronary angiography was performed without significant stenosis of coronary arteries. Laboratory tests revealed high level of GH which was not suppressed after glucose administration, high level of IGF-1. A magnetic resonance imaging scan revealed a 14 × 14 × 12 mm macroadenoma involving the pituitary gland. A diagnosis of acromegaly was established. Treatment by somatostatin analogues was initiated at dose 120 mg every 28 days. Control magnetic resonance imaging of the sella demonstrated a decrease of macroadenoma size (13 × 11 × 12 mm). Control echocardiography after 1 year of treatment showed improvement of left ventricle systolic and diastolic function (EF 33%). Nowadays trans-sphenoidal resection of macroadenoma is in the plan