Case Study: Unveiling Androstenedione’s Enigma in a 42-Year-Old Woman with Acromegaly
Introduction:
Ms. Ayesha, a 42-year-old woman, presented to the endocrinology clinic with a ten-year history of progressive facial features coarsening, hands and feet enlargement, and deepening voice. On examination, she exhibited characteristic acromegalic features like prominent jaw, thickened lips, and enlarged hands with spade-like fingers.
Her medical history revealed uncontrolled diabetes mellitus diagnosed five years ago and hypertension for two years. Her family history was unremarkable for endocrine disorders.
Diagnostic Workup:
Initial investigations confirmed acromegaly with elevated serum growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels. Pituitary MRI revealed a macroadenoma measuring 2.5 cm in diameter.
Further endocrine workup, however, revealed an intriguing finding: Ms. Ayesha had significantly elevated serum androstenedione levels compared to the reference range for women. This unexpected finding prompted further investigation into the potential role of androstenedione in her acromegaly.
Exploring the Androstenedione Connection:
To understand the potential contribution of androstenedione, the following investigations were performed:
- Sex hormone binding globulin (SHBG): Found to be within the normal range, ruling out decreased SHBG as a cause of elevated androstenedione.
- 17-beta hydroxysteroid dehydrogenase type 5 (17β-HSD5) activity: Normal levels of 17β-HSD5, an enzyme crucial for converting androstenedione to testosterone, suggested that excessive androstenedione production might be the culprit.
- Testosterone and estradiol levels: While testosterone levels were slightly elevated, estradiol remained within the normal range, indicating that androstenedione was likely not being efficiently converted to these sex hormones.
Clinical Implications:
Ms. Ayesha’s case presented a unique opportunity to explore the potential role of androstenedione in acromegaly. The elevated levels, in conjunction with normal SHBG and 17β-HSD5 activity, suggested an overproduction of androstenedione. This, along with the known virilization effects of androstenedione, could have contributed to some of Ms. Ayesha’s symptoms, potentially complicating the clinical picture.
Treatment Approach:
Given the complexity of Ms. Ayesha’s case, a multi-pronged treatment approach was implemented:
- Pituitary surgery: Transsphenoidal surgery successfully removed the macroadenoma, leading to normalization of GH and IGF-1 levels.
- Somatostatin analog therapy: Octreotide was prescribed to further suppress GH secretion and control any residual tumor activity.
- Metformin: To manage Ms. Ayesha’s diabetes and potentially address any insulin resistance contributing to elevated androstenedione levels.
- Monitoring of androstenedione levels: Regular monitoring of Ms. Ayesha’s androstenedione levels was crucial to assess its response to treatment and potentially guide further interventions.
Outcome and Prognosis:
Following treatment, Ms. Ayesha experienced significant improvement in her acromegalic symptoms. Her facial features refined, hand and feet size stabilized, and voice quality improved. Her diabetes and hypertension were also better controlled. Notably, her androstenedione levels gradually decreased towards the normal range, suggesting a link between tumor removal and hormonal balance.
Ms. Ayesha’s case highlights the potential significance of androstenedione in acromegaly. While further research is needed to fully understand its role and optimal management strategies, its inclusion in the diagnostic and treatment considerations for acromegaly patients like Ms. Ayesha could lead to improved symptom control and long-term outcomes.
Note: This case study is based on the information provided in the previous prompts and does not claim to represent actual medical practice. Always consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.