Recurrent Pericarditis in a Woman With Acromegaly Responding Favorably to Transsphenoidal Surgery

Acromegaly is associated with increased insulin-like growth factor 1 (IGF-1), promoting systemic inflammation and cardiovascular complications. We present a patient with acromegaly who developed recurrent pericarditis, resolving soon after somatotroph pituitary adenoma resection. The objective of this report is to describe a case of uncontrolled acromegaly with recurrent, unexplained pericarditis.

A 46-year-old woman was referred after a neurologist identified a 9 mm pituitary lesion on magnetic resonance imaging. Laboratory tests showed elevated IGF-1 of 52.3 nmol/mL (12.3-32.9 nmol/L), a nonsuppressible growth hormone (GH) level of 3.8 mcg/L (<0.4 mcg/L) after a 75 g oral glucose tolerance test, confirming acromegaly. One-year postdiagnosis, the patient developed pleuritic chest pain from pericarditis with moderate-to-severe pericardial effusion. Symptoms resolved with nonsteroidal antiinflammatory drugs, colchicine and pericardiocentesis. Over 3 years she experienced multiple episodes of recurrent pericarditis. A comprehensive diagnostic workup, including rheumatologic and infectious evaluations, was negative. After transsphenoidal adenoma resection, IGF-1 normalized, and medical therapy was discontinued. Pericarditis recurred 2 months postoperatively but has not occurred again over 12 years of acromegaly remission.

Hypersecretion of GH in acromegaly leads to elevated IGF-1 levels, which affect inflammatory responses. IGF-1 can promote systemic inflammation through proinflammatory cytokines, its effects may vary depending on tissue type. In this case, resolution of pericarditis following IGF-1 normalization suggests that elevated IGF-1 levels may mediate the inflammatory process in the pericardium.

The case suggests that acromegaly may predispose some patients to pericarditis, but its frequency and underlying pathogenesis remain unclear.