Acute Unprovoked Pulmonary Embolism As the First Presentation in Undiagnosed Acromegaly

The association between acromegaly and hypercoagulability may cause undiagnosed patients to present with venous thromboembolism. We present a man in his late 50s who attended the emergency department on account of pleuritic chest pain and shortness of breath. His past medical history included epilepsy (with a previous temporal lobe lobectomy) and prediabetes. Computed tomography pulmonary angiogram established a diagnosis of acute bilateral pulmonary emboli involving the right and left subsegmental pulmonary arteries, which warranted further investigation for a cause. No obvious provoking factors were found, and further CT imaging did not reveal any underlying malignancy. As the patient was noted on his admission clerking to have coarse facial features with enlarged hands and feet, endocrine evaluation was undertaken; elevated insulin-like growth factor-1, along with a positive oral glucose tolerance test, confirmed the diagnosis of acromegaly. The patient was discharged with anticoagulation and referred to the thrombosis clinic alongside an outpatient MRI of his pituitary, the findings of which were consistent with a pituitary macroadenoma.