Endocrinol Metab.  2015 Sep;30(3):395-401. 10.3803/EnM.2015.30.3.395.

Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation

• Lee HM
• Lee SH
• Yang IH
• Hwang IK
• Hwang YC
• Ahn KJ
• Chung HY
• Hwang HJ
• Jeong IK

• KMID: 2407092
• DOI: http://doi.org/10.3803/EnM.2015.30.3.395

Abstract

The leading cause of morbidity and mortality in patients with acromegaly is cardiovascular complications. Myocardial exposure to excessive growth hormone can cause ventricular hypertrophy, hypertension, arrhythmia, and diastolic dysfunction. However, congestive heart failure as a result of systolic dysfunction is observed only rarely in patients with acromegaly. Most cases of acromegaly exhibit high levels of serum insulin-like growth factor-1 (IGF-1). Acromegaly with normal IGF-1 levels is rare and difficult to diagnose. Here, we report a rare case of an acromegalic patient whose first clinical manifestation was severe congestive heart failure, despite normal IGF-1 levels. We diagnosed acromegaly using a glucose-loading growth hormone suppression test. Cardiac function and myocardial hypertrophy improved 6 months after transsphenoidal resection of a pituitary adenoma.

Keyword

Acromegaly; Heart failure; Insulin-like growth factor I

MeSH Terms

Acromegaly*
Arrhythmias, Cardiac
Estrogens, Conjugated (USP)*
Growth Hormone
Heart Failure*
Humans
Hypertension
Hypertrophy
Insulin-Like Growth Factor I
Mortality
Pituitary Neoplasms
Estrogens, Conjugated (USP)
Growth Hormone
Insulin-Like Growth Factor I

Figure

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  Fig. 1 Chest X-ray and echocardiogram findings showed marked cardiomegaly and left ventricle (LV) hypertrophy. (A) Marked cardiomegaly was detected on chest X-ray. (B) Echocardiogram showed an enlarged left atrium (LA) and LV with concentric LV hypertrophy.

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  Fig. 2 Clinical manifestations and radiographic findings showed the distinguishing features of acromegaly. (A) Jaw enlargement and frontal bone protrusion. (B) Soft tissue overgrowth of the hand (black arrow) compared with a normal adult hand (white arrow). (C) Soft tissue overgrowth of the heel pad in a foot X-ray.

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  Fig. 3 Magnetic resonance imaging of the sella showed a suspicious 5-mm linear shape delayed enhancing lesion at the midline to the left side of the pituitary gland (arrow).

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  Fig. 4 (A, B) Fundoscopic findings showed cotton wool patches and hemorrhage on both retinae.

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  Fig. 5 Pathological findings of the pituitary tumor identified it as a growth hormone (GH)-secreting adenoma. (A) A pituitary adenoma in the pituitary gland (H&E stain, ×200). (B) Immunohistochemical staining of the pituitary tumor tissue showed that tumor cells were uniformly positive for GH (×400).

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