Endocrine Abstracts

A 42-year-old man presented to an outside hospital in 2015 with a 5-year history of increasing shoe size, ring size and low mood. During this 5-year period, he was also diagnosed with type 2 diabetes mellitus and obstructive sleep apnoea. On examination, he had signs consistent with acromegaly. This was confirmed on biochemical testing with an IGF-1>1200 mg/l, along with partial hypopituitarism and raised prolactin. His formal visual fields testing demonstrated a bilateral...

A 28-year-old female presented with oligomenorrhoea and bilateral headaches in 2018. Initial blood testing revealed raised prolactin, prompting further assessment of pituitary function. This showed a high IGF-1(132 nmol/l), subsequent oral glucose tolerance test confirmed the diagnosis of acromegaly. It is worth noting that she did not exhibit many of the typical clinical features of acromegaly. MRI demonstrated a left-sided pituitary macroadenoma invading the cavernous sinus....

Summary: Due to the insidious nature of the condition, acromegaly is often diagnosed years after onset of symptoms. By this time, patients will often have developed metabolic and cardiovascular complications. But for this patient, he was most distressed by his changing physical appearance. The delay in diagnosis and subsequent wait for outpatient investigations and management progression caused him severe psychological distress. Clinical Case: A 39 year ...

A 34-year-old obese gentleman was referred in 2017 in view of larger coarsening hands (noted when wearing his wedding ring), bilateral palm paraesthesia, increased sweat production in his palms, and weight-gain despite not having changed his lifestyle. His past medical history included Grave’s disease treated with Carbimazole. On examination, the patient was noted to have a cavernous voice and prominent supraorbital ridges along with generalised facial coarseness. Initial...

Background: The post-treatment follow-up of acromegaly involves assessing treatment efficacy through biochemical evaluation, imaging studies for residual/recurrent disease, and monitoring clinical signs. IGF-1 normalization, typically achieved 12 weeks post-surgery, is considered a success; however, delayed normalization has been observed. Discordant GH/IGF-I results may indicate persistent somatotroph GH secretion and tissue responsiveness. We present a case where maximal med...

A 56 year old female who attends the general endocrine outpatient appointments for acromegaly secondary to pituitary macroadenoma diagnosed in March 2022. She has a history of breast cancer (HER2+), papillary thyroid cancer and is under active treatment for metastatic non-small cell lung cancer (adenocarcinoma) diagnosed in 2019. Her initial MRI pituitary was performed in March 2022 after an interval scan from oncology to assess disease response to treatment identified a pitui...

A 23-year-old Caucasian male was referred to Endocrinology with symptoms spanning over 7 years. He was substantially taller than other members of his family measuring 6’3”. He initially presented to Ophthalmology with preseptal cellulitis and noted to have visual field defects with acromegalic features. His pituitary profile showed GH > 100 mu/l, Total T4 104 nmol/l (normal: 60–140 nmol/l), Prolactin 234 mu/l, cortisol 240 nmol/l with flat GST. There was no ...

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), bunionectom...

42 year old female presented to ENT clinic in Nov 2020 with otitis externa and underwent CT mastoid which showed an incidental finding of right sellar / parsellar mass, confirmed later by Pituitary MRI in Nov 2020. Referred with an invasive pituitary parasellar adenoma with a size of 2.4 cm, sellar lesion which extends infrasellarly and into the cavernous sinus. Raised GH level which failed to suppress on OGTT with a low normal IGF-1 level. She had mild symptoms associated wit...

The case is presented of a 42 year old female who was admitted to hospital with an acute exacerbation of sarcoidosis. A CT of sinuses was performed which incidentally noted that the pituitary gland appeared enlarged. An MRI of the pituitary confirmed a moderately enhancing 21 × 26 × 22 mm pituitary macroadenoma which was displacing the chiasm superiorly. The patient reported that she had to increase the size of her wedding ring three times in the last three years and...

A 33-year-old patient with background of Bilateral achilles tendonitis, was referred to Endocrinology with raised IGF-1 and concern of acromegaly. Her symptoms included arthralgias and change in hand and feet size. Pituitary profile confirmed elevated IGF-1 181 nmol/l, otherwise normal pituitary profile. On OGTT, there was failure to suppress Growth hormone. Pituitary MRI revealed large macroadenoma with suprasellar extension, extension into right cavernous sinus with optic ch...

Introduction: Acromegaly is caused by excessive secretion of growth hormone (GH), usually by a pituitary adenoma, and a concomitant excess of insulin-like growth factor 1 (IGF-1). Excess GH and IGF-1 exert many actions on the cardiovascular (CV) system and especially on cardiovascular disease (CVD) risk factors which are common, especially in active acromegaly, but often persist after adequate treatment in patients with controlled disease.Clinical case: ...

A male patient was diagnosed with acromegaly in July 2007 (at the age of 38). His biochemistry showed IGF-1 123 (14.6-39.9) nmol/l; paradoxical rise in GH during OGTT; and evidence of hypopituitarism (Testosterone 5.2 nmol/l, LH 4.0 iu/l FSH 3.7 iu/l, SHBG 8 nmol/l and prolactin 112 mu/l) HBa1c 6.5%. MRI Pituitary revealed a poorly enhancing mass within the right side of the pituitary gland within a slightly expanded pituitary fossa. There was no parasellar extension, no compr...

50 M presented to our hospital with plantar foot pain and clawing of the toes in his right foot for a period of 12 months and a 4 month history of headaches. He was initially managed with physiotherapy and neurology undertook MRI scans. MRI: The pituitary gland is enlarged due to a right-sided hypoenhancing lesion measuring 9.5 × 9 × 6.5 mm. No further pituitary lesion is identified. The pituitary infundibulum is at the midline. The optic chiasm is not displaced. On ...

42 years old male referred to endocrinology for the symptoms of joint pains, lethargy, sweating and low testosterone levels. Medical history was consistent with obstructive sleep apnea established on CPAP machine. On examination high BMI, prominent lower jaw, and large hands were noted. Investigations confirmed raised IGF-1: 550 ng/ml (normal range 101-267), Low baseline cortisol 126 nmol/l, Low testosterone: 3.1 nmol/l, low LH:2 IU/l/FSH:1IU/l with normal thyroid function tes...