Endocrine Abstracts

A 40 year old male presented to his general practitioner with numbness in his fingertips, especially at night. Since his screening for peripheral neuropathy was unremarkable, he was called in for an in-person appointment to look for carpel tunnel syndrome. At the surgery he was noticed to have enlarged hands but he did not have any other complaints at that time. He missed his further appointments, until after 2 years when he presented with dental problems, protrusion of his lower jaw, with jaw pain. On further exploration he admitted increase in his shoe size along with increase in the size of both hands, coarsening of facial features, headache and occasional sweating. His IGF-1 was found to be raised and he was referred to endocrinology clinic for further evaluation. In clinic we noted a recent diagnosis of hypertension with atrial fibrillations. He also admitted the use of anabolic steroids in the past for body building, but was not sure about the use of growth hormone. He exhibited typical features of growth hormone excess including frontal bossing, frontal burrow, prominent nasolabial folds, prognathism, interdental separation and acral enlargement. His growth hormone levels and anterior pituitary functions were assessed and an oral Glucose tolerance test was arranged, which demonstrated failure to suppress growth hormone. This was followed by an MRI of his pituitary gland which showed a pituitary adenoma on the right measuring 17 mm with no chiasmal displacement or extension into the cavernous sinus. His case was discussed in a multidisciplinary meeting and he was planned to have trans-sphenoidal resection of pituitary adenoma after pre-surgical optimisation. Post operatively he was commenced on hydrocortisone replacement and day 3 Growth Hormone levels came back normal. His hypertension also improved and required reduced dose of anti-hypertensive. Specimen histology demonstrated a sparsely granulated somatotroph cell pituitary neuroendocrine tumour (pitNET)/adenoma. He was discharged with a planned follow up after 3 months. Normalizing mortality to the level in general population is the key aim in the management of acromegaly. Biochemical goal to control mortality is a GH less than 2.5 ng/ml or a normal age and sex-adjusted IGF-I levels. Co-morbidities such as hypertension, diabetes and cardiac diseases should be managed appropriately.