Patient Profile:
- Name: John
- Age: 45
- Gender: Male
Chief Complaint:
John presented to an endocrinologist with complaints of gradual changes in his physical appearance and health over the past few years. He reported enlarged facial features, hands, and feet, joint pain, fatigue, and headaches.
Case Presentation:
History and Initial Assessment:
John’s medical history revealed no significant health concerns until the past few years when he started experiencing the aforementioned symptoms. Physical examination showed enlarged hands, coarse facial features, and visual field defects.
Laboratory Investigations:
Blood tests were conducted to assess hormonal levels. Results showed:
- Elevated GH Levels: John had markedly elevated levels of growth hormone (GH) well above the normal range.
- Normal Cortisol Levels: His cortisol levels were within the normal range, although there was a lack of the expected suppression of cortisol in response to a glucose tolerance test.
Diagnosis:
Based on the clinical presentation and hormonal evaluation, John was diagnosed with acromegaly. Imaging studies revealed a pituitary adenoma responsible for the excess GH production.
Treatment:
- Pituitary Surgery: John underwent transsphenoidal pituitary surgery to remove the adenoma. The surgery was successful in reducing the size of the tumor.
- Postoperative Cortisol Management: Post-surgery, John’s cortisol levels were closely monitored, given the lack of cortisol suppression during the glucose tolerance test. He was diagnosed with impaired glucose tolerance, and cortisol replacement therapy was initiated to manage the risk of adrenal insufficiency.
- GH Monitoring: GH levels were regularly monitored to assess the effectiveness of the surgery and ensure GH suppression to normal levels.
Outcome and Progress:
Following pituitary surgery, John’s symptoms gradually improved. His facial features and extremities showed some reduction in size. GH levels returned to the normal range, indicating successful tumor removal.
John continued to receive cortisol replacement therapy as a precautionary measure due to the impaired cortisol response observed during the diagnostic phase. He also received regular follow-up care to monitor his hormonal levels, glucose tolerance, and overall health.
Conclusion:
John’s case illustrates the complexity of acromegaly diagnosis and management, including the interplay between GH and cortisol. Successful treatment required surgical intervention to address the pituitary adenoma responsible for GH excess. The management also involved careful monitoring of cortisol levels and the initiation of cortisol replacement therapy to mitigate the risk of adrenal insufficiency. This case underscores the importance of a multidisciplinary approach to acromegaly care, involving endocrinologists, neurosurgeons, and other healthcare professionals, to optimize treatment outcomes and enhance the patient’s quality of life.