Acromegaly: Diagnosis and Management in Patients Who Present with Discrepancy Between IGF-1 and GH
An 18-year-old woman presented with galactorrhea and was thought to have a prolactinoma. As acromegaly signs and symptoms progressed, she proved to have an elevated GH nadir on oral glucose tolerance test but IGF1 was initially normal. The disease progressed and IGF-1 became elevated over time. She required two pituitary surgeries and radiation in addition to medical therapies for acromegaly. The case of discrepancy between IGF1 and GH levels is discussed as well as the management strategy for aggressive cases of acromegaly in which disease persists after pituitary surgery.
KeywordsAcromegaly Growth hormone Insulin growth factor-1 Somatostatin analogs Radiation therapy