A 62-year-old Iraqi woman exhibited progressive enlargement of her hands, feet, and facial features over several years, accompanied by poorly controlled type 2 diabetes mellitus, hypertension, and dyslipidemia—metabolic disorders that had become increasingly challenging to manage despite conventional treatment. These gradual physical changes, which are often very small in middle-aged and older people, eventually made doctors think that the person might have acromegaly. Biochemical testing confirmed the diagnosis by showing consistently high levels of growth hormone, no suppression on oral glucose tolerance testing, and insulin-like growth factor-1 concentrations that were much higher than normal for someone of the same age and sex. A macroadenoma measuring 14 × 12 × 9 mm was found on a pituitary magnetic resonance imaging scan. There was no suprasellar extension, optic chiasm compression, or visual field problems on formal testing. After a thorough discussion of treatment options, the patient opted against transsphenoidal surgery, citing personal preference and apprehensions about surgical risks, and instead chose to initiate primary medical treatment. She began taking Sandostatin LAR (octreotide), a long-acting somatostatin receptor ligand, at a low dose that was gradually increased over the next few months based on how well she tolerated it and how her biochemical response changed. Regular follow-up lab tests showed that insulin-like growth factor-1 levels were steadily dropping toward the normal range. This showed that the excess growth hormone was being successfully suppressed. A follow-up MRI about a year into treatment showed a good response, with the adenoma getting smaller and cystic degeneration appearing in the tumor, which is what you would expect from somatostatin analog–mediated regression. This hormonal enhancement was accompanied by improved management of her metabolic comorbidities, including enhanced glycemic control, lowered blood pressure, and optimized lipid profiles, highlighting the close association between acromegaly and cardiometabolic complications. This case underscores the necessity of early recognition of acromegaly in patients primarily exhibiting metabolic disturbances and subtle physical manifestations, particularly when surgical intervention is not feasible. It also shows how effective somatostatin analogs can be as a powerful nonsurgical treatment that can help with biochemical control, tumor reduction, and overall metabolic health. In these cases, successful management depends on a personalized, multidisciplinary framework that includes regular endocrinological evaluations, hormonal monitoring, and periodic imaging. This is done to get the best disease control, reduce long-term complications, and improve quality of life.
Shehata et al. (Thu,) studied this question.