Endocrine Abstracts

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 her shoe size had also increased. She also reported that her facial appearance had changed and gaps were present between her teeth. She had no subjective visual disturbance. Multiple skin tags were noted on examination. There were no overt change in her bowels or weight loss. In addition to sarcoidosis, she had a history of asthma, vitiligo and hypothyroidism. IGF-1 was 736 mg/l. The remainder of her pituitary profile was normal. An oral glucose tolerance test with growth hormone was consistent with a diagnosis of acromegaly. HbA1 c confirmed pre-diabetes and she was commenced on Metformin. Formal visual field testing confirmed bitemporal hemianopia. She was commenced on Sandostatin LAR 10 mg every 28 days and referred for urgent review to a tertiary neurosurgical centre. Due to prolonged courses of steroid therapy for her sarcoidosis, she was commenced on maintenance hydrocortisone while awaiting a short synacthen test. She had a screening colonscopy with two polyps removed. On review in the outpatient clinic one month later, she reported an ongoing and significant headache since commencing Sandostatin LAR. CT brain noted a heterogeneous appearance of the known pituitary adenoma which may indicate some small volume internal haemorrhage. She was transferred to a tertiary neurosurgical centre and underwent an endoscopic transsphenoidal resection. She was well on review post-operatively and passed a short synacthen test. Post-operative IGF-1 was 692 mg/l. The remainder of her pituitary profile was normal. This case highlights the importance of taking a thorough history as this patient had many clinical features suggestive of acromegaly.