Endocrine Abstracts

Case: Acromegaly is associated with osteoarthritis due to soft tissue swelling. Our patient was first diagnosed with acromegaly in 2001 at the age of 51, subsequently undergoing a transsphenoidal pituitary adenoma resection in 2002, followed by postoperative radiotherapy in 2003, with subsequent development of anterior hypopituitarism. He has comorbidities of osteoarthritis, (having previously undergone bilateral total hip replacements and a left total knee replacement), bunionectomy with pinning of the right great toe in 2014, well-controlled T2DM, and a colonic polyp. He currently takes Hydrocortisone/levothyroxine/Tostran gel/Pegvisomant(GH receptor antagonist)/Omeprazole/Tramadol/Calcichew/Rosuvastatin/Metformin/Naproxen, and Lanreotide(somatostatin analogue). Although his acromegaly remains well controlled with a normal IGF-1, he still suffers from significant joint pain and experiences limited mobility as sequelae of his acromegaly. Due to his joint problems as a result of his acromegaly, he unfortunately had to stop working as a warehouse operative in 2011. Since leaving work, he has felt anergia and a lack of motivation. In an attempt to overcome this, between 2011 and 2020, he was volunteering regularly. On days when he was volunteering, he felt engaged and well, but on days when he was not working as a volunteer, he would find himself sleeping excessively with an absence of purpose. All of these activities finished with the Covid-19 pandemic, and since then, he has not been able to perform any voluntary work. His symptoms have since worsened, with a pronounced feeling of ‘pointlessness’ and continuing weariness. He believes his motivation would return if he regained structure to his life. Frustrations have also arisen due to no longer being able to perform simple ‘DIY’ household tasks, due to difficulty bending over and balancing on ladders. In January 2024 he was seen by an endocrinologist in a regional chronic fatigue syndrome clinic. It was felt that he did not have chronic fatigue syndrome but rather was experiencing reactive low mood as a result of a major change in his functional level over the last decade or so. On consultation with a clinical psychologist, it was felt that a referral to his local Social Prescribing Team would facilitate some low-intensity cognitive behavioural therapy while also putting him in touch with organisations who could potentially provide him with some structured and meaningful voluntary work. He continues to follow up with his endocrinologist.