Endocrine Abstracts

Introduction: Acromegaly is a rare metabolic condition in adults caused by over secretion of growth hormone from the pituitary gland. The characteristic skeletal and organ overgrowth and dental mal-occlusion issues are so insidious that they go unnoticed by the patient and family. The dentist may be the first healthcare provider to see these patients, thereby proving instrumental in early diagnosis. We report two cases of acromegaly: one case identified by a dentist and another case missed by a dentist.

Case 1: A 49-year-old man presented with a history of continued weight gain and change in appearance for over ten years. He had visited his dentist several times over many years for various dental issues. He had clinical features of acromegaly. His serum insulin-like growth factor-1 (IGF-1) level was elevated and a glucose challenge confirmed growth hormone excess. Imaging demonstrated a pituitary macroadenoma compressing the optic chiasm and invading the right cavernous sinus. He had trans-sphenoidal surgery followed by somatostatin analogue therapy for residual disease.

Case 2: A 59-year-old woman was referred by her dentist who noticed a significant increase in the size of her lower jaw. Examination revealed mandibular prognathism, large nose and large fingers. Blood tests revealed an elevated serum IGF-1 level. A glucose challenge test confirmed growth hormone excess. Imaging demonstrated a pituitary macroadenoma compressing the optic chiasm. She had trans-sphenoidal surgery and her IGF-1 levels remain in the normal range.

Conclusions: Acromegaly is a rare condition, however, early detection is required to minimise cardiovascular and metabolic risks and to reduce morbidity and mortality. The dental team should be made aware of the dental presentation of this condition as they can play a vital role in early detection and referral to the endocrinologist.