SHM Converge Scientific Abstract ePoster Gallery-The Hidden Growth: Unmasking the Diagnosis of Acromegaly

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This case describes a 68-year-old man with hypertension, type 2 diabetes, stable angina, and osteoarthritis who presented with acute dysphagia and dyspnea while eating, along with chronic right-sided neck and chest pain. Initial CT of the neck showed diffuse idiopathic skeletal hyperostosis with a large anterior C3/C4 osteophyte compressing the aerodigestive tract, raising concern for angioedema. However, treatment with diphenhydramine, dexamethasone, and famotidine did not help.<br /><br />Further evaluation revealed longstanding symptoms that had developed gradually over about 8 years, including tongue enlargement, increased shoe size, joint pain and stiffness, voice changes, weight gain, and dysphagia. Physical exam showed macroglossia, macrognathia, enlarged hands and feet, and limited neck motion, suggesting acromegaly. Chart review supported a long history of related complaints that had been treated separately.<br /><br />Workup included pituitary MRI showing a 3 mm lesion suspicious for microadenoma, elevated IGF-1, and an oral glucose tolerance test that did not rule out growth hormone excess. Cardiac testing showed reduced ejection fraction with hypokinesis. Neurosurgery was consulted, and the patient was discharged with endocrinology and neurosurgery follow-up. He later underwent transsphenoidal resection of the pituitary microadenoma.<br /><br />The case highlights how acromegaly can be overlooked because its features develop slowly and are often managed as unrelated problems. Early recognition matters because acromegaly is associated with significant cardiovascular, metabolic, and respiratory complications and reduced life expectancy. A careful history, chart review, and high index of suspicion are essential, especially for inpatient teams who may recognize the pattern.

Asset Subtitle

Jessica Cristallo

Meta Tag

Author List Allie Liebmann, Jessica Cristallo, Mohammed Kallash

Category Clinical Vignettes

Concept Acromegaly

Concept Insulin-like Growth Factor 1

Concept Acral Enlargement

Concept Oral Glucose Tolerance Test

Concept Pituitary Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Jessica Cristallo

Track Adult

Keywords

acromegaly

pituitary microadenoma

macroglossia

dysphagia

diffuse idiopathic skeletal hyperostosis

osteophyte compression

growth hormone excess

IGF-1 elevation

transsphenoidal resection

cardiovascular complications

Acromegaly

Insulin-like Growth Factor 1

Acral Enlargement

Oral Glucose Tolerance Test

Pituitary Magnetic Resonance Imaging