A Rare Case Of Pseudoacromegaly With Insulin Resistance

A 45-year old soldier presented with headache, polyuria and excessive weight gain for many weeks. He also noticed increase in shoe size, tightening of ring around his finger and coarsening of facial features with widening of nose and thickening of lips for last one year. He also complained of backache, electric shock like sensation in gloves and stocking distribution as well as excessive sweating and darkening of her skin in flexural areas. Examination revealed a large framed man with coarse facial features, large hands and feet, acanthosis nigricans and many skin tags. His past medical history was most significant for bilateral carpal tunnel syndrome requiring surgery in last 2 years and type 2 diabetes mellitus which recently was not even controlled on high doses of insulin. His serum insulin like growth factor 1 (IGF-1) and dynamic growth testing was normal. His MRI of pituitary fossa showed no mass while he had normal pituitary hormonal workup. He had marked elevation of fasting serum insulin, and mixed hyperlipidemia. His calculated insulin resistance based on HOMA-IR was very high. Based on negative MRI and clinical and biochemical features of insulin resistance a diagnosis of pseudoacromegaly was made. Pseudoacromegaly is a rare phenomenon that occurs in severe insulin resistance with acromegaloid phenotype in absence of raised growth hormone or IGF-1. Physicians should keep this possibility in mind while evaluating patients with similar clinical and radiological features.