Endocrine Abstracts

Background and aim: Acromegaly is a rare condition caused by an excessive secretion of growth hormone (GH) and insulin-like growth factor1 (IGF-1), which are responsible for exaggerated somatic growth and cardiometabolic disturbances. This study aims to describe the ophthalmologic complications seen in acromegaly.

Patients and Methods : We conducted a retrospective study (1997-2020) at the Endocrinology department of Hedi Chaker University Hospital, Sfax, Tunisia. We involved 30 patients diagnosed with acromegaly, whose clinical, biochemical, and imaging peculiarities were collected from medical charts. All patients had an ophthalmologic examination with a visual field.

Results : The mean age of diagnosis was 45.8±12.4 years with a male predominance (51.7%). The mean delay of diagnosis was 5.1±5.4 years. Pituitary tumor syndrome (PTS) (30%) and acrofacial dysmorphia (16.6%) were the main reasons for consultation. Pituitary MRI revealed a somatotropic macroadenoma in 82.8% of cases. Visual disorders related to STH were noted in 42.8% of our patients, such as monocular blindness (n=2), diplopia (n=4) and visual blur (n=7). A decrease in visual acuity was observed in 21.4%. Ophthalmological examination revealed papilledema and optic atrophy in 10.7% and 7.1% of cases respectively. Bitemporal hemianospsia (14.3%) and temporal quadranopsia (3.6%) were the most common visual field alterations.

Discussion: Somatotropic adenomas are characterized by an insidious evolution and a mostly a delayed diagnosis. Visual disorders generally translate a tumoral invasion at the expense of the cavernous sinus and the optic tracts. The initial evaluation of the visual impact by an ophthalmologic examination, visual field and pituitary MRI is strongly recommended. Preservation of the visual prognosis remains one of the major objectives of the treatment. A close collaboration between endocrinologist, neurosurgeon and ophthalmologist is necessary during all therapeutic steps.