What the mind knows but the eyes may still miss: reducing the ‘Acromegalic Window’

Abstract

A 46-year-old Asian man was referred to our endocrine unit (April 2013) by his general practitioner for investigation of a neck mass. Ultrasound scan of the neck and serum thyroid-stimulating hormone levels revealed a euthyroid multinodular goitre. He presented with symptoms of frequent headaches, polydypsia, polyuria, perspiration and night sweats and demonstrated classic physical features of acromegaly. In retrospect, the patient's medical history included encounters with numerous physicians from an array of specialties for over 20 years, mostly for symptoms well recognised to be attributed to growth hormone (GH) excess. Random insulin-like growth factor-1 level was elevated at 103 nmol/L (normal 13-37 nmol/L) and oral glucose tolerance test showed non-suppressible GH secretion (15.06 mIU/L at 120 min). MRI revealed a mildly enlarged pituitary gland. The patient has been referred for surgery. This case highlights that, even with classic features of acromegaly, there may be a wide-ranging 'Acromegalic Window' between first presentation and clinical suspicion to eventual diagnosis.

Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database

“…Given the range of potential signs/symptoms and the specific problems caused by a pituitary adenoma, it is crucial that awareness of pituitary tumors continues to be widened across medical specialties and related groups ( Surchi et al 2017 ). Delays in diagnosis in patients that attend with multiple symptoms of acromegaly still occur as illustrated clearly by De and Foucault, leading to unnecessary exposure of excessive GH/IGF-1 ( De & Foucault 2014 ). Interestingly, in the age of widespread Internet searching related to medicine, as many people or friends/family diagnosed himself or herself with acromegaly as did ophthalmologists.…”