Abstract
Acromegaly is commonly caused by a growth hormone (GH) secreting pituitary adenoma, which is often evident on pituitary imaging by the time of presentation. Here we describe 4 patients with acromegaly who had normal MRI of the pituitary at the time of diagnosis. Contrast enhanced computer tomography (CECT) chest and abdomen were also normal. All 4 patients were females and aged 45, 53, 69 and 70 years. They had acromegaloid features of varying severity and duration. Dynamic magnetic resonance imaging (MRI) was performed in 3 patients, which revealed pituitary microadenomas in all 3 of them. This highlights the heterogenous behavior of GH secreting tumours and the value of dynamic MRI in visualizing microadenomas.
Highlights
Is a progressive multi system disease associated with significant morbidity and nearly 2 fold increased mortality [1, 2]
The maximum image contrast between the normal pituitary tissue and microadenomas is attained about 30-60 seconds after the bolus injection of the intravenous contrast [6]
The peak enhancement of the pituitary adenomas occurs after the most marked enhancement of the normal pituitary gland, and persists for a longer duration [7]. Both spatial and temporal resolution must be sufficiently high in order to visualize a micro adenoma
Summary
Is a progressive multi system disease associated with significant morbidity and nearly 2 fold increased mortality [1, 2]. Since the diagnosis of acromegaly is often delayed by an average of 4-10 years, pituitary adenomas are often large and visible on MRI. Conventional MRI pituitary did not reveal any lesions. Features of acromegaly such as enlarged lips, nose and prominent supraorbital ridges were quite obvious in this patient (Figure 1 - No.3).
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