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An unusual cure for acromegaly.

Sibylle Kohler1, Oliver Tschopp, René Ludwig Bernays

  • 1Endocrinology Department, University Hospital Zurich, Zurich, Switzerland. sibskohler@gmx.ch

BMJ Case Reports
|September 11, 2012
PubMed
Summary

A rare intrasellar abscess led to the cure of acromegaly in a patient previously resistant to multiple treatments. This unexpected outcome resolved the need for growth hormone-lowering medications.

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Area of Science:

  • Endocrinology
  • Neurosurgery
  • Infectious Diseases

Background:

  • Acromegaly, a disorder caused by excess growth hormone, often requires multimodal treatment including surgery, radiation, and medication.
  • This patient had persistent acromegaly despite transcranial and transsphenoidal surgeries, and stereotactic radiosurgery.
  • Medical management with octreotide and pegvisomant was necessary to normalize growth hormone levels.

Observation:

  • Seven years post-acromegaly diagnosis, the patient experienced sudden vision loss and meningism.
  • An intrasellar abscess was identified as the cause of these acute symptoms.
  • The abscess was successfully treated with surgical drainage.

Findings:

  • Following surgical drainage of the intrasellar abscess, the patient achieved a complete cure of acromegaly.
  • She was able to discontinue both octreotide and pegvisomant, indicating normalization of growth hormone secretion.
  • The abscess resolution unexpectedly resolved the underlying acromegaly.

Implications:

  • This case highlights a rare but potential curative pathway for acromegaly through infection-induced abscess resolution.
  • It suggests that infectious processes in the pituitary region can, in rare instances, lead to remission of pituitary adenomas.
  • Further investigation into the mechanisms by which intrasellar abscesses may resolve acromegaly is warranted.

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