MON-LB069 When a Routine Postoperative Internal Medicine Consultation Unearths a Hidden Diagnosis

Although rare in incidence, acromegaly can present with secondary osteoarthritis due to anabolic effects of Growth Hormone (GH). The diagnosis can be potentially missed until later in its clinical course, leading to a lost opportunity to prevent further complications and irreversible changes attributed to acromegaly. A 32-year-old patient with history of mild Type 1 Von Willebrand (VW) disease and severe crippling bilateral osteoarthritis of the hips was admitted for elective right hip replacement. The etiology of the osteoarthritis was not clear, but was felt to be unlikely to be related to VW disease, in the absence of hemarthrosis. A routine Internal Medicine consult was requested by the Orthopedics service for co-management of the patient postoperatively as he was on placed on VW factor infusion. Intraoperative findings were notable for severe osteopenia and destructive deformity of the femoral head. On examination, the patient was moderately built with largely normal systems examination. Closer examination revealed prominent supraciliary arches and nose. Large hands were noted with sausage like appearing digits. On further questioning, patient mentioned that his shoe size has increased to size 13 from size 10 in the last 3-4 years. A comparison of a previous picture of his face (5 yrs. ago) to now confirmed the pronounced changes in facial features. He recalled his dentist mentioning about significant spacing between his teeth a year ago. An insulin like growth factor 1 (IGF1) level was ordered as a first part of the work up for Acromegaly. The level returned back at 1448 ng/ml (53-332 ng/ml). An MRI scan of the brain revealed a large macro-adenoma extending onto the right cavernous sinus and displacing the optic chiasma. He was referred to the pituitary clinic for further work up and ultimately underwent a partial 2 stage trans nasal endoscopic resection of the tumor followed by fractionated radiotherapy. He continues to be on octreotide and pegvisomant. With the increase in childhood obesity, there has been an increased incidence of osteoarthritis in young patients. The need for joint replacement in relatively young patients has also increased. While it is important to pursue joint replacement surgeries in these patients to prevent disability, careful evaluation of the cause of OA must be looked into, especially in young patients. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.