LATE DIAGNOSIS OF ACROMEGALY IN THE SETTING OF A SOMATOPROLACTINOMA

Acromegaly is a chronic neuroendocrine disorder caused by excessive secretion of growth hormone and insulin-like growth factor-1, leading to systemic metabolic and organ dysfunction, substantial comorbidity, and an increased risk of premature mortality. This article presents a clinical case of a 47-year-old woman with a somatoprolactinoma in whom delayed diagnosis of acromegaly resulted in multiple complications. The disease began at a young age, manifesting as amenorrhea and progressive changes in appearance. Despite comprehensive treatment-including transsphenoidal adenomectomy, stereotactic radiosurgery (CyberKnife), and therapy with somatostatin analogues-sustained normalization of growth hormone, IGF-1, and prolactin levels was achieved; however, the patient continues to exhibit significant complications, including optic nerve atrophy, hypopituitarism, cardiomyopathy, and arthropathy. Immunohistochemical analysis was not performed at the initial surgery in 2004. However, in 2012, a re-evaluation of archival histological slides was conducted, including a complete immunohistochemical workup, which demonstrated strong expression of growth hormone and prolactin. Thus, the tumor was definitively classified as a pituitary somatoprolactinoma. This clinical case highlights the diagnostic and therapeutic challenges associated with acromegaly, the necessity of a multidisciplinary approach, the importance of early diagnosis, and the value of long-term dynamic follow-up of patients.