Suspected Acromegaly - Looking for Ectopic Hormone Production.

Introduction: Acromegaly is a slow-progressing disease caused by excessive secretion of growth hormone, typically by pituitary adenomas. Ectopic tumors, such as those in the lungs or pancreas, are a rare cause. Acromegaly associated with ectopic GHRH secretion is more common in women. Case Report: The 48-year-old man underwent head contrast computed tomography (CT) and pituitary magnetic resonance imaging (MRI) due to persistent headaches, but no lesions were found. Outpatient tests showed elevated levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Physical examination revealed coarse facial features, enlarged hands and feet, hyperhidrosis, and snoring. During hospitalization, elevated levels of IGF-1 and serotonin were noted, along with paradoxical GH release during an oral glucose tolerance test and abnormal thyroid hormone levels. Chest X-ray showed opacity in the right lung. The patient, diagnosed with acromegaly, also had obesity, hypertension, left ventricular hypertrophy, impaired fasting glucose, and cholelithiasis. Treatment with liraglutide was initiated. Ectopic sites of GH secretion were investigated, revealing emphysematous bullae and nodules in the lungs, as well as suspicious findings in the anterior mediastinum. Subsequent hospitalization showed normal thyroid and gonadal function, and MRI showed no pituitary lesions. Conclusion: This case illustrates the difficulties in diagnosing acromegaly. Pituitary hyperplasia visualized on imaging studies does not always indicate pituitary acromegaly, as it could result from hypertrophy due to ectopic GHRH secretion. Although ectopic acromegaly is rare, it should always be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]