Endocrine Abstracts

Case History: We present a case of a 52-year-old female with a history of right adrenalectomy at age 30, insulin-dependent Type 2 diabetes, and atypical clinical manifestations mimicking acromegaly. The patient presented with a five-year history of worsening facial appearance, blurry vision, and a noticeable hunch in the back. Notably, she had undergone right adrenalectomy for an adenoma in the past and had never received steroid therapy post-surgery. Despite presenting with features suggestive of acromegaly, including insulin resistance evidenced by a markedly elevated HbA1c of 99, comprehensive diagnostic evaluations were pursued.

Investigations: Pituitary profile hormones including TSH and Magnetic Resonance Imaging (MRI) Pituitary revealed no abnormalities, and the oral glucose tolerance test (OGTT) demonstrated normal glucose metabolism with appropriate suppression of insulin-like growth factor 1 (IGF-1) and growth hormone. Additionally, the Dexamethasone suppression test and 24-hour urinary free cortisol was normal, effectively excluding Cushing syndrome.

Results and Treatment: Given the absence of biochemical evidence of acromegaly and other related disorders, the patient was diagnosed with pseudo-acromegaly. The emphasis shifted towards addressing the underlying insulin resistance due to features of obesity and acanthosis nigricans with biochemical confirmation of raised C peptide and Insulin levels, and lifestyle modifications were recommended, particularly weight loss, to improve glycaemic control.

Conclusion and Points for discussion: Pseudo- acromegaly is a rare condition characterized by acromegalic features without the associated growth hormone excess seen in true acromegaly. This case underscores the importance of considering pseudo-acromegaly in patients presenting with acromegalic features, especially in those with a history of adrenalectomy and atypical clinical manifestations. Timely and thorough diagnostic evaluations are crucial to exclude underlying endocrine disorders and guide appropriate management strategies, emphasizing the significance of addressing insulin resistance in the absence of growth hormone excess.