Endocrine Abstracts

Introduction: Acromegaly is, in most cases, caused by growth hormone (GH) -secreting pituitary adenomas that lead to characteristic phenotypical changes. Its association with emty sella (ES) has been described and different theories has been given to explain such situation. Moreover, patients with acromegaly often develops different pathologies of the thyroid gland, however, the occurrence of grave’s disease (GD) is quite a rare situation. Here we report a case of a patient diagnosed with grave’s disease and acromegaly which was caused by a GH secreting adenoma and associated to an ES.

Case report: A 64-year-old female patient was referred for investigation of recent diabetes mellitus imbalance. For her personal medical history, she has been treated for hypertension and sleep apnea for 17 years now, and was operated for gonarthrosis and carpal tunnel syndrome in both hands 15 years ago. Regarding her family history, her first daughter was diagnosed with GD and the second daughter was followed for hyper prolactinemia due to an empty pituitary sella. Clinically, she was complaining of thermophobia, trembling, polyuro-polydipsic syndrome and weight loss. On examination, she had facial features of acromegaly with enlargement of her hands and feet and a goiter. Her blood pressure was often high. Biochemical testing revealed an elevated insulin-like growth factor-1 and a suppressed thyroid stimulation hormone (TSH) with positive anti-TSH-receptor antibodies. A pituitary Magnetic resonance imaging was performed, revealing an 11-mm adenoma with empty sella and no signs of local invasion. No history of pituitary apoplexy was described by the patient. A transphenoidal surgery was successfully performed and the diagnosis of GH-producing adenoma was also confirmed with immunohistochemistry. For her hyperthyroidism, she was treated with anti-thyroid drugs with a fast remission after 4 months of treatment.

Conclusion: The occurrence of an ES with a pituitary microadenoma has been described in many cases in literature; however its association with a macroadenoma is quite rare. One of the multiple physiopathological theories would be a paracrine effect of the growth hormone on the sellar bone. Moreover the combination of GD and acromegaly is not a commun situation, representing 1% of thyroid pathology in acromagalic patients.