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1998 Presentations for the Poster and Vignette Sessions
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"I CAN'T GET MY WEDDING RING OFF." - A CASE REPORT OF ACROMEGALY. Susan A. Kamper, M.D. Marshfield Clinic/St. Joseph's Hospital, Marshfield, WI.

Acromegaly is a rare condition that results from the excess production of growth hormone in the anterior lobe of the pituitary gland. It is characterized by excessive skeletal growth and soft tissue enlargement. A 49 year old Caucasian female with past medical history only significant for renal lithiasis presented with a one year history of headache, weight gain, inability to remove her wedding ring despite resizing approximately five years ago, change in shoe size from an eight to a ten over five years, and an inability to wear lower dentures. Her family also complained of increasing snoring. Physical exam was positive for coarse facial features, grossly enlarged tongue which interfered with her speech, protuberant mandible, twice normal diffusely enlarged thyroid gland, and thickening of the soft tissue of the hands and feet.

Initial studies included a skull X-ray revealing a "ballooning" of the sella turcica. MRI confirmed a pituitary macroadenoma. Significant laboratory studies included IGF-1 580 (normals 32-93); otherwise, prolactin, thyroid, HbA1C and electrolytes were normal. The patient subsequently underwent transsphenoidal resection of the macroadenoma. Pathology revealed adenoma producing prolactin and growth hormone. Post-op IGF-1 level was 124. She is currently being treated medically with bromocriptine 5 mg PO TID.

Acromegaly patients suffer significant long-term morbidity and mortality from respiratory and cardiovascular disease, as well as cancer. The primary goal of treatment is rapid and complete normalization of growth hormone levels. This has proven to be difficult, despite surgical, pharmacological and radiological treatments. Special emphasis is on medical management, including somatostatin analogues.

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