Acromegaly Discovered After Head Trauma: Multivessel Coronary Disease and Postoperative Meningitis Complicating a...

Acromegaly is a rare endocrine disorder caused by chronic growth hormone (GH) excess, most often from a pituitary somatotroph adenoma. Because the somatic and metabolic features develop slowly, the diagnosis is often delayed for years. We report the case of a 59-year-old man whose acromegaly was identified incidentally after a 1.6 cm pituitary macroadenoma was found on MRI obtained for trauma evaluation following a bicycle accident. History and examination revealed several long-standing features of acromegaly, including widely spaced teeth, mild prognathism, increased shoe and hand size, severe obstructive sleep apnea (OSA), worsening hypertension, recently diagnosed type 2 diabetes mellitus, and secondary hypogonadism. Biochemical testing confirmed the diagnosis with a peak insulin-like growth factor 1 (IGF-1) of 752 ng/mL and a random GH of 10.9 ng/mL. Routine preoperative cardiac evaluation identified previously unrecognized multivessel coronary artery disease requiring four coronary stents, and the resulting need for dual antiplatelet therapy delayed transsphenoidal resection by approximately seven months. Endoscopic transsphenoidal resection was performed in March 2025, with rapid GH normalization and no residual tumor on postoperative imaging. The early postoperative course was complicated by bacterial sinusitis and subsequent bacterial meningitis treated with intravenous cefepime and linezolid. By three months postoperatively, IGF-1 had normalized, and the patient had achieved substantial weight loss and improved glycemic control, although follow-up polysomnography showed worsening OSA despite biochemical remission. This case illustrates the diagnostic delay typical of acromegaly, the impact of unrecognized cardiovascular comorbidity on surgical timing, and the infectious complications that can follow transsphenoidal surgery.