Spontaneous Resolution of Acromegaly with Marked Hypopituitarism – a Case Report
Author: Shishkov, Savi R., Dimitrova, Radina S., Hadzjieva, Elica G., Yaneva, Zhaneta A., Ivanova, Iva V., Siderova, Mira V., Hristozov, Kiril H.
Acromegaly is a disease caused by a chronic overproduction of growth hormone. In 95% of cases it is a result of pituitary adenoma. The aims of treatment are to remove the tumor mass or to achieve control over the tumor growth with somatotropin levels that will reduce the mortality risk to that of the general population. The first method of choice is transsphenoidal adenomectomy. Radiotherapy is preferred in inoperable or high risk patients. In order to achieve control over the disease medical therapy also comes into consideration. In rare instances, with varying clinical symptoms, a spontaneous cure following pituitary apoplexy (PA) is possible. We present a case of a patient with features of acromegaly and clinical and laboratory evidence of hypopituitarism. Magnetic resonance imaging demonstrates an empty sella turcica. The patient has history of an ischemic strok e and he was also treated for tuberculosis meningitis. In light of the past medical history we assume that a spontaneous cure had occurred as a consequence of asymptomatic apoplexy. Despite that we do not exclude tuberculosis as part of the ehiopathogenesis. Regardless of the exact mechanism by which the complete absence of pituitary structures developed in this patient, the coexistence of empty sella syndrome with clinical features of acromegaly is an unusual finding. On the other hand, concerning the replacement therapy there remains an open question whether growth hormone deficiency should be substituted after the cure of acromegaly.