LATE DIAGNOSIS OF ACROMEGALY IN THE SETTING OF A SOMATOPROLACTINOMA

Area of Science:

• Endocrinology
• Neuroendocrinology
• Oncology

Background:

• Acromegaly, a chronic disorder from excess growth hormone and IGF-1, causes systemic dysfunction and increased mortality.
• Somatoprolactinomas are pituitary tumors secreting both growth hormone and prolactin, posing diagnostic challenges.

Purpose of the Study:

• To present a clinical case of a 47-year-old woman with a somatoprolactinoma and acromegaly.
• To highlight the consequences of delayed diagnosis and the complexities of treatment and long-term management.

Main Methods:

• Case report of a patient with amenorrhea and physical changes.
• Treatment included surgery (transsphenoidal adenomectomy), radiosurgery (CyberKnife), and somatostatin analogues.
• Immunohistochemical re-evaluation of archival slides confirmed a somatoprolactinoma.

Main Results:

• Sustained normalization of growth hormone, IGF-1, and prolactin levels was achieved.
• The patient developed significant long-term complications: optic nerve atrophy, hypopituitarism, cardiomyopathy, and arthropathy.
• Definitive diagnosis of pituitary somatoprolactinoma confirmed by immunohistochemistry.

Conclusions:

• This case underscores the diagnostic and therapeutic challenges in acromegaly management.
• Emphasizes the need for early diagnosis, a multidisciplinary approach, and long-term patient follow-up.
• Highlights the importance of immunohistochemistry in pituitary tumor classification.