Acromegaly With Normal Pituitary Mri and No Identifiable Ectopic Secretion: Whats the Challenge?

Somatotropic pituitary adenoma is the most common etiology of acromegaly, most often detected at the macroadenoma stage. Some cases of acromegaly with normal pituitary magnetic resonance imaging (MRI) have been described in the literature, necessitating the search for an ectopic origin, which may also be normal this is a rare entity whose management and follow-up are not codified. Exploratory pituitary surgery or medical treatment with somatostatin analogues, dopaminergic agonists, or growth hormone (GH) antagonists may be proposed as a treatment. We report a case of acromegaly with normal pituitary MRI and no identifiable ectopic secretion, in which we opted for medical treatment with somatostatin analogues to stabilise the disease and limit its complications, with active monitoring of biological and morphological parameters.