Atypical Presentation in a Lady with Acromegaly : A Case Report
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Date
2024-11
Journal Title
Journal ISSN
Volume Title
Publisher
THE INDIAN MEDICAL ASSOCIATION
Abstract
Background : The blood IGF-1 level is a suitable marker for assessing the integrated secretion of GH and is advised for acromegaly diagnosis, monitoring and screening. Systemic diseases like Catabolic Disorders, Liver or KIdney Failure, Malnutrition and Diabetes Mellitus can lower IGF-1 levels and cause acromegaly screening to give false-negative results. Case Report : A 49-year-old female presented with dysphagia, vomiting, abdominal distention with no associated pain but Grade 3 edema of both lower limbs, with frontal bossing, prominent jawline, and acral thickening. The abdomen was distended with fluid thrill otherwise unremarkable. Ascitic fluid showed predominantly mononuclear cells with an elevated protein (4.56 mg/dL) and normal ADA. Ascitic culture was negative with no evidence of malignant cells found. Lower levels of IGF-1, LH, FSH were observed with elevated TSH and Prolactin. Ultrasonography of the abdomen suggested Chronic Liver Parenchymal Disease with massive ascites. Doppler study of lower limbs showed DVT. Heel pad thickness of 30.7 mm and 26.4 mm on the left and right sides respectively. MRI of the Brain showed Pituitary Macroadrenoma (13 mm). Discussion : IGF-I concentrations correlated with heel pad thickness, fasting blood sugar concentrations and response to an OGTT in patients with acromegaly. Low IGF-1 in the context of clinical acromegaly may also indicate a later stage of a disease process that was once linked to high IGF-1 and caused the clinical signs of acromegaly but has now “burned out”. Recent research has shown that acromegaly patients may have coagulation abnormalities causing hypercoagulable states and, therefore, increasing the risk of Thrombosis. Conclusion : Renal or hepatic disease or impaired nutritional status should be viewed as confounding conditions and may cause alterations in IGF-I production and/or bioactivity, such that the IGF-I concentration may no longer accurately reflect disease activity.
Description
Keywords
Acromegaly, IGF-1, VTE
Citation
Purkayastha Arnab, Bhattacharjee Prithwiraj, Khakholary Madhusmita . Atypical Presentation in a Lady with Acromegaly : A Case Report. Journal of the Indian Medical Association. 2024 Nov; 122(11): 61-65