Endocrine Abstracts

Acromegaly is a rare endocrine disorder mostly caused by a growth hormone (GH)-secreting pituitary adenoma. The aim of treatment is to normalize GH/IGF1 levels to limit disease burden. Growth hormone hypersecretion is associated with an increased cancer risk; cases of Acromegaly complicated by lymphoma have been reported. We share a clinical case characterized by suboptimal treatment, potentially leading to advancing orbital lymphoma. This 49-year-old man was diagnosed with Acromegaly secondary to a pituitary macroadenoma in 2018. He was treated with Octreotide LAR and Cabergoline as the tumour was initially deemed unresectable. GH hypersecretion was seemingly controlled with averaged normal IGF1. The patient retained physical signs of Acromegaly and developed progressive cardiometabolic complications. Interestingly, a concomitant but unclear diagnosis of orbitopathy was made. In 2018 an MRI scan showed diffuse soft tissue infiltration involving both orbits however this was not followed up. At our department, in 2022, the patient underwent a pituitary and orbit MRI, showing a pituitary macroadenoma extending into the right cavernous sinus, and progression of disease in the left orbit, threatening the optic nerve. A colonoscopy and echocardiogram identified a benign tubular adenoma and left ventricular hypertrophy, respectively. Following MDT discussion, pituitary surgery and orbital biopsy were performed. Histology confirmed a somatotroph adenoma. The orbital biopsy was highly suggestive of B cell lymphoma; a total body CT was unremarkable apart from a left adrenal incidentaloma. Adrenal biochemistry and MEN screen were normal. This is an intriguing case where potentially curative treatment was delayed which may have led to progressive cardiometabolic complications and malignancy. A growing collection of case reports have reported an association between Acromegaly and Lymphoma, especially with the B cell subtype. This clinical case highlights the importance of prompt treatment and supports a link between Acromegaly and B cell lymphoma.