Androstenedione-Patient: Mrs. A, a 42-year-old woman, diagnosed with acromegaly four years ago.
Presenting Symptoms: Over the past year, Mrs. A has noticed:
- Increasingly prominent facial and body hair growth (hirsutism).
- Oily skin and persistent acne breakouts.
- Irregular menstrual cycles and decreased libido.
- Enlargement of hands and feet.
- Fatigue and headaches.
Medical History: No prior hormonal conditions or medication use. Otherwise healthy.
Physical Examination: Acanthosis nigricans (dark velvety patches on skin) on neck and armpits. Enlarged hands and feet with prominent ridges.
Laboratory Findings:
- Serum GH: 85 ng/mL (significantly elevated)
- IGF-1: 580 ng/mL (elevated)
- Androstenedione: 8 ng/mL (mildly elevated)
- Testosterone: 80 ng/dL (within normal range)
- Estradiol: 50 pg/mL (within normal range)
- DHEA: 400 ng/mL (normal)
- Insulin: 25 mU/L (slightly elevated)
- Liver function tests: Normal
Diagnosis: Acromegaly with elevated androstenedione levels.
Discussion: Mrs. A’s case exemplifies the potential impact of elevated androstenedione in acromegaly. While her GH and IGF-1 levels confirm the primary diagnosis, the mildly elevated androstenedione sheds light on potential downstream effects.
The hirsutism and acne likely stem from the accumulation of androstenedione, a weak androgen with noticeable effects in females. The irregular menstrual cycles further suggest a hormonal imbalance potentially contributing to PCOS development.
While Mrs. A’s androstenedione levels are not significantly high, her insulin resistance might play a role, as hyperinsulinemia can stimulate adrenal and ovarian androgen production. Additionally, GH’s aromatase-suppressing effect could contribute to androstenedione accumulation.
Management:
- Initiating GH-lowering therapy with somatostatin analogs is crucial to control acromegaly progression.
- Monitoring androstenedione levels alongside GH and IGF-1 to assess treatment effectiveness and androgen-related symptoms.
- Considering anti-androgen medications like spironolactone or topical treatments to manage hirsutism and acne, if lifestyle modifications (e.g., hair removal) are insufficient.
- Addressing insulin resistance, if significant, to potentially improve menstrual regularity and androgen levels.
Prognosis: With proper GH control and targeted management of androgen-related symptoms, Mrs. A can experience improved symptom control and quality of life. The case highlights the importance of considering diverse hormone interactions in acromegaly for optimizing treatment and patient well-being.
This case study demonstrates the intricate interplay between GH, androstenedione, and clinical manifestations in acromegaly. It underscores the need for comprehensive hormonal evaluation and personalized treatment strategies for optimal patient outcomes.
This case study provides a concrete example of the concepts discussed in the general article. It personalizes the information by focusing on a specific patient and their clinical presentation. By including laboratory findings, diagnosis, management strategies, and prognosis, the case study offers a practical representation of the complex relationship between acromegaly and elevated androstenedione.