A rare presentation of acromegaly: Hypercalcemia

INTRODUCTION: Acromegaly is a chronic disease in which adenoma composed of somatotroph cells causes excessive GH secretion. There is an increase in morbidity and mortality with the metabolic effects of GH secretion and the mass effect due to the compression of the adenoma. Hyperphosphatemia and hypercalciuria are seen at a rate of 30–60% in Acromegaly patients, which are presenting symptoms in our case. CLINICAL CASE: A 56-year-old woman presented with headache, weakness, sweating, and pain in the bones of the hands and feet, which had started within last one year. In the examinations, hypercalcemia and hyperphosphatemia were detected. The patient had a history of Hashimoto's thyroiditis, Addison's disease, Sjögren's syndrome and type 2 diabetes. She uses levothyroxine, hydroxychloroquine, hydrocortisone and metformin as treatment. In our evaluation, skin turgor was found to be decreased. Laboratory tests; Ca 12.1 (8.5–10.4) mg/dl, Albumin 3.9 gr/dl, P 5.6 (2.4–5.5) mg/dl PTH 1.8 (12–72) pg/ml, PTHrP<0.5 pmol/L, 25 (OH) Vit D 34 (30–70) ng/ml, 1.25 dihydroxyvitamin D3 35 (30–70) ng/L. Multiple myeloma and other malignancies were excluded, sarcoidosis and other granulomatous causes were ruled out. The patient was euthyroid and mobile. The patient has no history of vitamin A and thiazide use. She was using hydrocortisone 30 mg/day because of Addison. Insulin-like growth factor (IGF-1) 394 ng/ml (93–245), GH 1.76 ng/ml was detected. 0, 1. and 2nd hour in oral glucose tolerance test (OGTT)-GH; hour GH/glucose values were 2.5/91, 1.07/166, 4.02ng/ml /211mg/dl, respectively. Sella MRI revealed a 5×3.5 mm adenoma in the left pituitary gland. Figure-1 Pituitary adenoma in sella MRI (coronal and sagittal sections) [Figure: see text] Figure 2 The course of PTH and Ca The operation could not be performed early in the pandemic conditions, and the treatment was started with sandostatin 20 mg/28 days. Control IGF-1 was 212 ng/ml, serum Ca 9.4 mg/dl, PTH 23 ng/ml. CONCLUSION: In case of hypercalcemia, it is recommended to consider also the diagnosis of Acromegaly and to check the IGF-1 level.