Background

Acromegaly is a rare and chronic disease, associated with increased mortality as the diagnosis is often delayed until clinical features set in. Suspicion of diagnosis arises with classic phenotypic features in the presence of a pituitary lesion and is confirmed by failed suppression of growth hormone levels. Incidental diagnosis prior to manifestation of any clinical signs and symptoms is unusual.

Objective

To highlight the virtue of incidental findings during routine radiological investigations and their impact on the management of the patient.

Methods

A 19-year-old female presented to the A&E with head injury following a road traffic accident. A CT head done to exclude head injury incidentally showed a significant pituitary macroadenoma and she was referred to endocrinology. She had a history of headaches for 3-4 months on left side with no sinister features and no other features suggestive of hormonal excess. Her past medical history included well-controlled asthma and no significant family history. Clinical examination showed no acromegalic features but a weight of 16.5 stone, a height of 5ft 8in, and a BMI of 34.7.

Results

1) MRI Pituitary – 22x19x17mm pituitary macroadenoma with no signs of compression of optic tract. 2) A complete pituitary profile - unremarkable except for an IGF-1 (insulin-like growth factor) of 127.1nmol/L 3) Formal visual fields- normal, 4) Oral Glucose Tolerance test with growth hormone (GH) suppression- fasting glucose 15.4 and GH 4.44mcg/L. 5) HbA1c 73 6) Gene analysis - negative.

Conclusions

She was discussed in pituitary MDT and referred to Neurosurgery. She was started on Long-acting Octreotide while awaiting surgery and metformin for the diabetes. She underwent Transsphenoidal resection of the pituitary successfully and developed transient Diabetes Insipidis and hypoadrenalism. This resolved 2 months post-surgery and she is now well and off all medication, for regular radiological surveillance.