Endocrine Abstracts

Menstrual irregularity is common in women with acromegaly, occurring in 40–84% of patients. Its pathogenesis is still not well established although it is usually attributed to prolactin excess and/or gonadotropin deficiency. Also, since the presence of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) receptors is demonstrated in the myometrium, a pathogenetic role of GH in the development of myoma is examined through different studies. Moreover, some of them particularly emphasise increased risk of developing neoplasms in patients who had been untreated for a long period of time, pointing out the significance of an early diagnosis. A 40-year-old female underwent endocrine assessment for hypertensive paroxysms characterised with sudden rise in blood pressure, up to 190/120 mmHg, over the past 4 years despite the treatment with ACE inhibitor and calcium channel blocking agent. She also reported headaches, deepening of her voice, change in facial features, enlargement of hands and feet (shoe size increased in one number) and secondary amenorrhea. Family history was positive for carcinoma and heart disease. On physical examination, typical acromegalic features were present. Hormonal examination revealed IGF-1 554 ng/ml (58.2–219 ng/ml), IGFBP3 8.23 mg/ml (3.3–6.6 mg/ml), luteinizing hormone (LH) 8.23 mIU/l, follicle-stimulating hormone (FSH) 4.38 mIU/l, estradiol 90 pg/ml, testosterone 1.42 nmol/l along with a modest increase in serum prolactin level (999.74 mIU/l). Thyroid hormones, cortisol and PTH were all in reference range. Pituitary magnetic resonance imaging (PMRI) showed a macroadenoma 21 × 17 × 18 mm with extrasellar extension into the suprasellar region. Further examination showed two large uterine myomas measuring 88 mm and 64 × 56 mm respectively. The patient underwent transsphenoidal surgery and patohistology was consistent with plurihormonal somatotrophic adenoma (GH, prolactin, TSH). After surgery, Hydrocortisone supplementation was started. On six months follow-up, control PMRI demonstrated residual tumour 18 × 8 mm, GH 0.2...0.9 ng/ml, IGF-1 157 ng/ml, IGFBP3 4.80 mg/ml, LH 5.01 mIU/l, FSH 5.59 mIU/l, prolactin 92.74 mIU/l. Amenorrhea is still present along with occasional rises in blood pressure. The patient refuses a proposed surgical treatment of uterine myomas. Concerning patient`s current clinical status, the use of somatostatin analogue is beeing considered due to its effects on tumour rest and proposed role in a reduction in uterine and myoma volume. Menstrual abnormalities should be expected in woman with acromegaly. Therefore, all of them should undergo periodic screening for endometrial neoplastic lesions.