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Endocrine Abstracts (2024) 99 EP210 | DOI: 10.1530/endoabs.99.EP210

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Pseudoacromegaly – a challenging entity in the endocrine clinic: why you need to know about it?

Pedro Marques 1,2 , Inês Sapinho 3 & Marta Korbonits 4


1Hospital CUF Descobertas, Lisbon, Portugal, Endocrinology Department, Lisbon, Portugal; 2Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal; 3Hospital CUF Descobertas, Endocrinology Department, Lisbon, Portugal; 4William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Centre for Endocrinology, London, United Kingdom


Introduction: Pseudoacromegaly encompasses a group of conditions in which patients have clinical features of acromegaly or gigantism, but no GH or IGF-1 excess. With systematically reviewing all published cases (n=76) of patients with pseudoacromegaly who were evaluated due to a clinical suspicion of acromegaly, we identified key distinguishing features which need to be recognized.

Materials and Methods: A systematic search using the terms pseudoacromegaly, acromegaloidism and acromegaloid was conducted. Pseudoacromegaly cases were carefully checked to ensure they met eligibility criteria: 1) presentation suggestive of acromegaly and investigation triggered by acromegaly-related manifestations; 2) acromegaly was excluded based on normal serum GH, IGF-1 and/or GH suppression on oral glucose tolerance test (OGTT-GH); 3) definitive diagnosis of the underlying pseudoacromegaly condition was established.

Results: Of the 76 included cases, 47 (62%) were males, with mean ages at presentation 28±16 yrs (mean±SD) and at first acromegaloid symptoms 17±10 yrs. Most cases were reported from Asia (42%). Over half 57% were directly referred to Endocrine departments. The most common conditions were pachydermoperiostosis (47%) and insulin-mediated pseudoacromegaly (24%), followed by Cantú (8%) and Berardinelli-Seip (4%) syndromes. Insulin-mediated pseudoacromegaly cases were more often referred to endocrine departments, whereas pachydermoperiostosis to non-endocrine physicians. Acromegaloid facies (75%) and acral enlargement (80%) were the most common features; other prevalent acromegaloid features included hyperhidrosis (36%), pachydermia (32%), arthralgia (29%), macroglossia (25%), prognathism (25%), acanthosis nigricans (25%) and tall stature (20%). Prevalence of acromegaloid physical features and tall stature was higher in cases referred to endocrine specialists (33% vs 6%; P=0.003). GH/IGF-1 axis assessment was heterogeneous: random GH was reported in 65%, IGF-1 in 79%, OGTT-GH in 51%. GH excess was more frequently ruled out based on 2 tests combined (53%); 3 tests were applied in 22%. Pituitary MRI was performed in 30 cases, being normal in 19, while a pituitary adenoma or hyperplasia were reported in 8 and 3 patients, respectively. Investigation patterns differed between cases managed by endocrine and non-endocrine specialists, the former requesting more often IGF-1, OGTT-GH and pituitary MRI.

Conclusions: Pseudoacromegaly is a challenging entity that may be encountered by endocrinologists, with pachydermoperiostosis and insulin-mediated pseudoacromegaly being the conditions most identified as mimicking acromegaly. Adequate assessment of GH/IGF-1 is crucial to rule out acromegaly, which may be better performed by endocrine specialists. Pituitary incidentalomas are common in the pseudoacromegaly setting and require careful judgment to prevent inadequate management.

Volume 99

26th European Congress of Endocrinology

Stockholm, Sweden
11 May 2024 - 14 May 2024

European Society of Endocrinology 

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