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Case Reports
. 2013 Jan 17:2013:bcr2012007604.
doi: 10.1136/bcr-2012-007604.

Where is the culprit? A case of acromegaly that defied the management algorithm

Celito A Tamban  1 , Mark Anthony S Sandoval, Frances Lina Lantion-Ang
Affiliations
Case Reports

Where is the culprit? A case of acromegaly that defied the management algorithm

Celito A Tamban et al. BMJ Case Rep. .

Abstract

A 30-year-old Filipino man presented with a 11-year history of coarse facial features and progressive enlargement of hands and feet. Initial work-up revealed elevated insulin-like growth factor-1 and non-suppressible growth hormone level after 75 g glucose challenge test. Initial cranial MRI performed in the year 2010 showed absence of pituitary adenoma. The patient was lost to follow-up. He again consulted in the year 2011 and a repeat cranial MRI and a dedicated pituitary MRI were performed and both did not reveal any pituitary mass. Further investigation included chest and abdominal CT scan, both of which did not show any neoplasm. At present, there has been no practice guideline on the management of acromegalic patients on whom the identifiable source cannot be found. The patient was given the option to undergo surgical exploration of the pituitary gland or medical treatment with somatostatin analogues. He decided to undergo surgery but has not given consent for the procedure.

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Figures

Figure 1
Figure 1
Coarse facial features (enlarged frontal and nasal bone, thickened facial and scalp skin including the periorbital area, thickened lips).
Figure 2
Figure 2
Enlarged hands.
Figure 3
Figure 3
Enlarged feet.
Figure 4
Figure 4
Cranial MRI which revealed normal result. Arrow pointing to the normal pituitary gland.
Figure 5
Figure 5
Repeat cranial MRI which did not show any pituitary mass. Arrow pointing to the normal pituitary gland.
Figure 6
Figure 6
Dedicated pituitary MRI which did not show any pituitary mass. Arrow pointing to the normal pituitary gland.
Figure 7
Figure 7
Chest CT scan which did not show any neoplasm.
Figure 8
Figure 8
Abdominal CT scan which did not show any neoplasm.
See this image and copyright information in PMC

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