Endocrine Abstracts

Introduction: Acromegaly is commonly associated with numerous cardiovascular manifestations such as left ventricular hypertrophy, hypertension and ischemic heart disease. However, initial presentation with dilated cardiomyopathy is relatively rare. Dilated cardiomyopathy in patients with acromegaly usually result from an extended and excessive exposure of the myocardium to growth hormone.

Case presentation: 51-year-old female with background medical history of hypertension presented with altered level of consciousness and non-sustained ventricular tachycardia. After stabilization, echocardiography confirmed severe dilated Cardiomyopathy (EF 18%). She had implantable cardioverter-defibrillator inserted. Based on cardiology team high clinical suspicion of acromegaly, she was referred to endocrinology team. Investigations showed IGF-1 level of 123 nmol/l (NR 5.5-32.0). She failed oral glucose tolerance test with non-suppressed growth hormone of 37.4 ug/l. Pituitary MRI showed large pituitary macroadenoma extending into the left cavernous contacting optic chiasm without compression. Visual field showed minor superior deficit. Case was discussed at pituitary MDT with recommendation for medical therapy with somatostatin analogue (Lanreotide) with plan to proceed to endoscopic resection of the pituitary tumor. During follow-up, IGF1 improved on Lanreotide to 34.3 nmol/l and cardiac function improved EF of 51%. Repeated MRI showed no more cavernous sinus involvement. Patient is planned to undergo pituitary surgery.

Conclusion: Cardiac abnormalities are the most common cause of morbidity and mortality in patients with acromegaly. Although there is no guidelines for acromegalic cardiomyopathy, current consensus recommends trans-sphenoidal pituitary surgery as the treatment of choice for acromegalic cardiomyopathy. In cases with high risk for immediate surgical intervention, somatostatin analogue therapy with octreotide has been reported to have good clinical and echocardiographic improvement.