From PCOS to Acromegaly: Diagnostic Challenges in a Young Female Patient | Chapter 2 | Medical Science: Updates and Prospects Vol. 4

 

Background: Hirsutism, though common in women of reproductive age, is classically associated with polycystic ovarian syndrome (PCOS). It is rarely seen as a prominent feature of acromegaly because of its lack of specificity and occurrence. Acromegaly is caused by chronic hypersecretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Diagnosis of acromegaly remains a challenge when the patient may have only subtle features of insulin resistance and PCOS in women.

 

Case Presentation: This study reports a case of a 28-year-old female with a 3-year duration of oligoamenorrhea and hirsutism. She was followed by a gynaecologist who retained the diagnosis of polycystic ovary syndrome (PCOS). After 5 years, the patient complained of increased hand, finger, and shoe size. She was referred to the endocrine department for suspicion of Acromegaly. Clinical examination revealed acromegaloidism features with mandibular prognathism and moderate macroglossia wic. Biological investigations were significant for elevated insulin-like growth factor 1 (IGF-1) level (774 ng/ml, normal: 98-290 ng/ml) and a growth hormone level not suppressed by a glucose challenge test. MRI brain revealed a pituitary macroadenoma (10.7x14 mm). The patient underwent an uncomplicated transsphenoidal resection of a pituitary macroadenoma. Immunohistochemistry demonstrated a GH tumour. The patient subsequently had normalisation of growth hormone dynamics and regular menstrual cycles.

 

Discussion: The cause of hirsutism in acromegaly is not well known. In acromegaly, chronic elevated growth hormone levels result in elevated total and free IGF-1. Patients with acromegaly are often insulin-resistant due to the insulin-antagonistic effects of elevated circulating growth hormone. GH decreases sex hormone binding globulin levels, which leads to increased free testosterone levels in patients with acromegaly despite normal testosterone levels.

 

Conclusion: This case highlights the importance of looking out for subtle features of acromegaly in patients with hirsutism and going for hormonal investigation to make the diagnosis of acromegaly at an earlier stage of the disease. Early diagnosis is critical to prevent the long-term morbidity and mortality associated with acromegaly, as it is a potentially life-threatening condition.

 

 

Author(s) Details

Manel Jemel Hadiji
National Institute of Nutrition and Food Technology Department of Endocrinology Tunis Tunisia, Manar University Tunis, Tunisia.

 

Mahdi Kalthoum
National Institute of Nutrition and Food Technology Department of Endocrinology Tunis Tunisia, Manar University Tunis, Tunisia.

 

Hajer Kandara
National Institute of Nutrition and Food Technology Department of Endocrinology Tunis Tunisia, Manar University Tunis, Tunisia.

 

Wafa Mimita
National Institute of Nutrition and Food Technology Department of Endocrinology Tunis Tunisia, Manar University Tunis, Tunisia.

 

Sonia Nagi
National Institute of Neurology Department of Neuroradiology Tunis Tunisia, Manar University Tunis, Tunisia.

 

Ines Kamoun
National Institute of Nutrition and Food Technology Department of Endocrinology Tunis Tunisia, Manar University Tunis, Tunisia.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6655