Acromegaly presenting as cardiac failure

In acromegaly, specific structural and functional changes in the heart appear to contribute to the increased mortality in this disease. This disease is uncommon in Nigeria, West Africa and little has been published about it; also rare is clinically evident heart failure. We are therefore highlighting a late presentation of acromegaly as heart failure.

A 45-year-old woman presented with a 4-year history of progressive increase in body size, lactation and amenorrhoea, and a six-week history of worsening symptoms of heart failure. Physical examination showed coarse facial features, spade like hands and feet, pitting pedal edema, galactorrhoea, and features of congestive cardiac failure. Chest radiograph showed gross cardiomegaly. On skull radiograph, destruction of the floor of the pituitary fossa was noted, with erosion of the clinoid processes. She had hyperprolactinamia. Fasting and post-glucose growth hormones values were elevated. Echocardiography revealed features of both diastolic and systolic dysfunction with left ventricular hypertrophy and dilation. A diagnosis of acromegalic cardiomyopathy in severe congestive heart failure was made. She was managed with anti-heart failure drugs with good results and subsequently began on a dopamine agonist. She was lost to follow up.

Acromegaly is uncommon in our practice. This patient presented late with complications. Management was very difficult because of the combination of severe complications and lack of resources.