Endocrine Abstracts

Introduction: Acromegaly is a chronic disease that occurs as a result of excessive growth hormone secretion, caused by somatotropin-secreting tumors of the pituitary gland in 98% of cases. The first line of treatment for these patients is operative via transsphenoidal approach, however, absolute remission is not achieved in 50% of patients and pharmacological therapy is indicated.

Case report: We will present the case of a 43-year-old patient who was hospitalized at the endocrinology department in 2016 due to enlargement of the hands, feet and nose, galactorrhoea as well as secondary amenorrhea. Elevated basal growth hormone (GH) values were verified: 79.05 ng/ml, there was no suppression in the oral glucose tolerance test, which established the diagnosis of acromegaly. NMR of the pituitary gland was performed, and described a macroadenoma of size 31×31×20 mm (LL×KK×AP) with expansion into the suprasellar cistern and cavernous sinuses on both sides. Operative treatment was indicated by the neurosurgeon, and conducted via transsphenoidal approach. After that, she was examined on several occasions by an endocrinologist from a lower reference center with persistently high IGF1 values but never came to our institution. She came to our centre in 2023 because of headaches, poorly regulated diabetes and hypertension. Again she had elevated basal GH values with the absence of suppression in the oral glucose tolerance test (GH 0 30, 60, 90, 120 min: 210 - 245 - 216 - 193 - 210 ng/ml), as well as high IGF1 443, 9. NMR of the pituitary gland was obtained and it showed deformed sella turcica, with a macroadenoma that spreaded parasellarly on both sides, invading both cavernous sinuses, compressing the optic nerves and the optic chiasm. Octreotide LAR 30 mg was introduced into the therapy immediatelly. A neurosurgeon was consulted again and a reoperation was indicated and performed. Postoperatively, elevated values of IGF1 persisted - 760 ng/ml, and the application of octreotide LAR was continued. Since she continuously had elevated levels of IGF1, we planned on introducing pasireotide or pegvisomant into the therapy, but that was not possible at this moment, given that these drugs are not available in our country.

Conclusion: As already mentioned in the introduction, the treatment of acromegaly is complicated and in most cases requires a combination of therapeutic modalities since transsphenoidal surgery does not lead to complete remission. We will also consider other therapeutic modalities (such as radiation).