Endocrine Abstracts

Introduction: Acromegaly is a debilitating, indolent disease that develops over several years due to extended exposure to elevated growth hormone (GH) levels. It is most commonly caused by somatotropinomas. It represents a rare pathology with an incidence of 3–14 cases per 1 million inhabitants and a prevalence of 40 to 90 cases per 1 million inhabitants. Pituitary adenomas respresent a challenging disease in young patients. Transphenoidal surgery is the best therapeutic option, but in many cases complete biochemical control is difficult to obtain, often requiring adjuvant therapy.

Materials and methods: We present the case of a male patient, 22 years old, diagnosed in 2014 with somatotropinoma. Clinically, on admission, the patient presented drug resistant headache, decreased visual acuity, extremities enlargement and arthralgia. Biological, the patient had elevated IGF–11 (726.9 ng/ml) and basal GH (116 ng/ml) levels and gonadal insufficiency. The MRI evaluation revealed the presence of an invasive macroadenoma (32/36/26 mm), with the inclusion of the optic chiasm and severe bitemporal hemianopsy. The recommendation at diagnosis was transphenoidal adenomectomy, performed in the same year. Postoperatively, the patient presented multiple postoperative complications with the development of global pituitary insufficiency. Postoperative biochemical profile improved, but with GH secretion (10.2 ng/ml) persistence and elevated IGF-1 concentrations (712.6 ng/ml). Treatment with somatostatin analogs and dopamine agonists was initiated after surgery, but GH secretion pursued (6.73 ng/ml). GH receptor antagonist therapy was added to the initial regimen, normalizing IGF-1 concentration (388.00 ng/ml), but with persistent GH secretion (7.78 ng/ml). Radiation therapy with conventional fractionated photons or radiosurgery with proton beam is recommended in this case.

Results: The patient presented a GH secreting pituitary macroadenoma with multiple acute postoperative complications, not responsive to drug therapy. The patient developed multiple complications of acromegaly, impairing quality of life and darkening long term prognosis.

Conclusions: Treatment of acromegaly is challanging in pituitary macroadenomas, especially in young patients. Early diagnosis with therapeutic interventions can improve disease complications, improving quality of life.