Challenge of Dealing with Acromegalic Patient with Non-Culprit Lesion

Abstract

Acromegaly in commonly caused by GH secreting pituitary adenoma, which are a nearly always identifiable in conventional magnetic resonance (MRI). Rarely encountered, a patient with normal pituitary MRI, pose a diagnostic and therapeutic challenge. In this case a work up for ectopic acromegalic source of GH/GHRH should be considered. We herein report the case of a 60-year-old woman in whom we confirmed the GH excess. However, the imaging studies failed to identify the source of this pathology. Pituitary MRI failed to find an identifiable adenoma in MRI. The work up of ectopic GH/GHRH tumor was negative. In the lack of standard guidelines, our case is added to those reported in the literature to review the diagnostic challenge and management in such acromegalic patients.