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Swollen and painful foot as the first sign of acromegaly

Introduction Acromegaly occurs due to high secretion of growth hormone The most common cause is an anterior pituitary adenoma Some of the most common symptoms are headache/vision loss, increased cartilage and soft tissue growth (enlarged mandible, swollen and/or enlarged extremities) and sleep apnea Case report 67 y o man with known arterial hypertension and prostatectomy due to adenocarcinoma was examined for pain in his right foot after physical exertion, with swelling of both feet During examination, accentuated facial bones, an enlarged nose, ears, hands and feet were noticed Basic laboratory findings were unremarkable An endocrinologic examination was recommended Additional laboratory findings showed elevated IGF 1 118 nmol/L) and GH in OGTT 34 7 g/L) MRI of sellar region showed pituitary macroadenoma 21 mm in diameter) Glucose intolerance was diagnosed, while other pituitary and gland hormones and ACTH test were normal The patient also complained that his old shoes were tight, he snored heavily, woke up at night and was drowsy during the day, sweated and had morning headaches Trans sphenoid ablation of pituitary macroadenoma was performed and pathohistological findings revealed eosinophilic pituitary adenoma with ability to synthesize GH and TSH Postoperatively, laboratory findings and sellar MRI were normal, and further follow up was recommended Conclusion The clinical features of acromegaly are attributed to high serum concentrations of GH and IGH 1 Somatotropic adenomas can also cause symptoms due to local expansion Surgical treatment of pituitary adenoma and strict control of the biochemical balance of pituitary hormones is required to achieve a complete therapeutic effect for acromegaly

acromegaly ; headache ; growth hormone ; macrognathia ; pituitary macroadenoma

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