Complete remission of acromegaly with medical treatment

A 40-year-old patient with a ten-year history of acromegaly had persistent disease despite prior treatment with conventional pituitary radiotherapy and two transsphenoidal hypophysectomies. Initial evaluation showed characteristic acromegalic features, hypertension, amenorrhea, inappropriate diaphoresis, and poorly controlled diabetes mellitus despite isophane insulin suspension daily. Growth-hormone levels were high and did not suppress with glucose load. Treatment with bromocriptine was associated with prompt improvement in glucose intolerance, with elimination of insulin requirement within 72 hours of institutions of this therapy. Blood pressure normalized; inappropriate diaphoresis disappeared. Within three months ovulatory menses were noted to resume for the first time in ten years. There was progressive improvement in the soft-tissue changes of acromegaly. The growth-hormone levels fell within three hours after the first dose of bromocryptine and remained suppressed throughout her six-month course of therapy.