7932 A Case of Acromegaly with Recurrence After Spontaneous Transient Resolution
Authors: Tadisina Shourya , Mohammed Sobrina Sarah , Patel Vaishali Bhavin 
Published: October 2024

Abstract
Disclosure: S. Tadisina: None. S.S. Mohammed: None. V.B. Patel: None.
Introduction: Pituitary apoplexy occurs from hemorrhage or infarction of the pituitary gland; a rare complication of pituitary adenomas. Pituitary apoplexy is a life-threatening endocrine emergency but can occasionally be asymptomatic. When occurs in a functional adenoma it can cause resolution of hormonal hypersecretion and remission. We describe a case of Acromegaly with transient spontaneous resolution likely from possible infarction of the pituitary adenoma which later developed recurrence with increasing Insulin like growth factor (ILGF-1) levels and size of the pituitary adenoma. Case Presentation: A 56-year-old male with history of multinodular goiter, prostate cancer on androgen deprivation therapy (ADT) presented for his thyroid but was found to have coarse facial features with widely spaced teeth on exam. He reported that he noticed these symptoms for about 2-3 years along with significant weight gain, increase in shoe size and ring size. Work up revealed evidence of acromegaly with elevated ILGF-1- 607 ng/ml (50-317ng/ml) and an oral glucose tolerance test that did not suppress growth hormone (GH) to &lt;1 ng/dl. Rest of the anterior pituitary hormonal work up was normal except for a low testosterone level due to ADT. Initial MRI Pituitary showed a small pituitary gland with decreased enhancement in the inferior Sella slightly more eccentric to the left. This could be a collapsed cyst; no mass effect as expected with an adenoma. Radiology and Neurosurgery reviewed imaging and confirmed a 3mm pituitary microadenoma. Serial hormonal work up revealed a downtrend in the ILGF-1 levels with normal values at 182 ng/ml at 8 months from initial evaluation. A multidisciplinary pituitary conference was held and the case was diagnosed as Acromegaly with spontaneous partial resolution. This case has a unique presentation as the imaging findings were not consistent with the biochemical and clinical findings making this a diagnostic challenge. A plausible explanation is that a spontaneous bleed or infarction of the adenoma could have caused it to shrink in size and biochemical improvement. He was closely monitored with serial imaging, biochemical and clinical evaluation. The follow up ILGF-1 levels done at 4 months from resolution showed increase to 407 ng/dl and a follow up MRI done at 10 months from the initial MRI showed a hypo enhancing pituitary adenoma 0.7x0.7x0.8 cm. Neurosurgery recommended surgical resection due to the increase in size and the ILGF-1 levels. This recurrence was thought to be likely from only partial infarction/bleed of the adenoma causing regrowth from the residual cells. Conclusion: Pituitary apoplexy causing complete/partial resolution of acromegaly can be a diagnostic and therapeutic challenge. There are few cases reported in literature with spontaneous resolution of acromegaly and only one case with recurrence after 18 years of apparent cure.
Presentation: 6/2/2024