Endocrine Abstracts

Section 1: Case history: A 19-year-old Caucasian female presented to the A&E department with a head injury following a road traffic accident. A CT head done to exclude head injury was normal but incidentally showed a significant pituitary macroadenoma and she was referred to endocrinology as out-patient urgently. This was delayed by 4 months due to face-to-face clinics being suspended in the first wave of the pandemic. Virtual consultation revealed a history of headaches for 3-4 months on the left side with no sinister features. No change in ring size or shoe size was noted. Her past medical history was significant for well-controlled asthma and no significant family history. Clinical examination was delayed for 6 months since referral, however, there were no acromegalic features noted, weight was 16.5 stone, height 5ft 8in, and BMI 34.7.

Section 2: Investigations: Investigations were requested virtually- 1) MRI Pituitary confirmed a significant pituitary macroadenoma with no signs of compression of optic tract. 2) A complete pituitary profile including short syncathen test - unremarkable except for an IGF-1 of 127.1 nmol/l 3) Formal visual fields- normal, 4) Oral Glucose Tolerance test with GH suppression- fasting glucose 15.4 and GH 4.44 mg/l. 5) HbA1c 73 6) Gene analysis for AIP, CDC73, CDKN18, and MEN1(RET) – all negative.

Section 3: Results and treatment: She was discussed in pituitary MDT and referred to Neurosurgery. She was started on Octreotide LA while awaiting surgery and metformin for diabetes. She underwent TSS resection successfully.

Section 4: Conclusions and Points for Discussion: Post-surgery she developed transient DI and hypoadrenalism. This resolved 2 months post-surgery and she is now completely well and off all medication including metformin. She is now regularly followed up with radiological surveillance. - Acromegaly is a rare, chronic disease, associated with increased mortality. - Suspicion of diagnosis typically arises with classic phenotypic features and raised IGF-1 levels, confirmed by failed suppression of GH levels. - Usually patients with acromegaly are identfied once the clinical features and associated complications of bowel polyps, nasal tract, diabetes and cardiovascular system have set in. - Incidental diagnosis prior to the manifestation of any clinical signs and symptoms is rare. - This has a significant impact on morbidity and mortality of the patients. - In a world where over-investigation with radiology is often criticized due to benign incidental findings, this case makes a strong point for the benefit of continuing the same.