THU022 A Case Of Delayed Diagnosis Of Acromegaly

Abstract

Abstract Disclosure: K. Blanchard: None. C. Musurakis: None. A. Havrylyan: None. A 57-year-old hispanic female with hypertension, prediabetes, hyperlipidemia, and uterine leiomyomata with hysterectomy one year ago presented to our emergency department with sensations of numbness, tingling, and pressure on the top of her head for 12 days’ duration and left eye blurred vision with photosensitivity for 3 days’ duration. Physical exam was significant for evident enlarged facial features including macroglossia, macrognathia, separation of teeth, enlarged lips, enlarged ears and increased size of hands and feet with thickening of the skin on the fingers and toes. Many skin tags were noted on the neck and chest. She reported noticing these changes gradually over the past five years, as well as noticing an increase in shoe size and ring size. Admission labs were significant for IGF-1 965 ng/mL (47-236), Glucagon 172 ng/mL (0.05-8.00), AM cortisol 24 ug/dL (6.7-22.6), ACTH 29.6 pg/mL (7.2-63.3), FSH 13.22 mIU/mL (16.74-113.59), LH 3.79 mIU/mL (10.87-58.64), and Prolactin 24.3 ng/mL (2.74-19.64). Hemoglobin A1c was 5.8% (<5.7) and lipid profile was significant for triglycerides of 202 mg/dL (<150). TSH was within normal limits. A chest x-ray showed no cardiomegaly. An echocardiogram showed no cardiomyopathy. A CT scan of the brain showed a hyperdense sellar/suprasellar mass measuring 2.1 x 0.7 x 2.4 cm with mass effect on the optic chiasm and intracranial optic nerve not excluded. An MRI brain confirmed a large pituitary macroadenoma measuring 2.7 x 2.5 x 2.2 cm with mass effect on the optic chiasm and pituitary stalk. In addition to the above workup, we recommended Neurosurgery evaluation for symptomatic macroadenoma with optic chiasm mass effect, Ophthalmology evaluation for visual fields testing, and referral to a tertiary care center for evaluation and treatment of acromegaly. The patient was discharged with Neurosurgery and Endocrinology outpatient follow-up, but unfortunately did not attend her appointments. Acromegaly is a rare condition with a prevalence of 60 cases per million. While the mean age of occurrence is 32 years, the mean age of diagnosis is 40 to 45 years, highlighting a persisting delay in the diagnosis. The changes associated with acromegaly occur slowly and therefore can be overlooked by the patient, their family members, and even physicians. Left untreated, continued exposure to increased levels of growth hormone and IGF-1 leads to development of comorbidities including Cushing’s disease, cardiovascular disease, diabetes, arthralgias, decreased bone mineral density, sleep apnea, and uterine leiomyomata, as well as increased mortality and decreased quality of life. This case highlights the importance of physicians in all specialties being familiarized with the symptoms and physical features of acromegaly to aid in timely diagnosis. Presentation: Thursday, June 15, 2023