Pseudo-acromegaly: a few comments

From the desk of Lewis S Blevins Jr. MD – cofounder.  I’m not sure this term really exists. It does, however, seem to be rather fitting at times. I encounter patients who look acromegalic but don’t have the disorder based on classic biochemical tests or else have elevated IGF-I levels but don’t seemingly have acromegaly based on classic physical features in the setting of absence of the pituitary tumor.

The first thing to keep in mind, when evaluating a patient who looks acromegalic, but does not have the classic biochemistry, is that they may have had the disease process and had infarct of a tumor. In most of these patient’s, there is radiographic evidence of an enlarged sella turcica and a distorted normal gland. These patients are out there. I see them. Fortunately, if the biochemistry is normal, there are no specific required treatments for the disorder. Many do, however, require treatment for some of the chronic comorbidities of the disease state.

As implied, some patients look acromegalic, have normal biochemistry, and normal MRI of the pituitary. There is an old disorder called acromegaloidism used to describe these patients. In my opinion, many of these patients probably have had insulin resistance with very high insulin levels which can cause growth of body tissues. Pregnancy is associated with placental production of human chorionic somatomammotrophin and human placental lactogen which causes an acromegaloid appearance in some pregnant women. Some people have familial prognathism where the lower jaw looks large and broad as can be seen in acromegaly. Others have Isolated thickened scalps with ridges, cutis vertica gyrata, that can also be seen in acromegaly. This patient’s have none of the other features of acromegaly.

It is not unusual to see patients who have elevated IGF-I levels, detected by routine screening, and no other evidence for acromegaly by physical exam, and they have a normal MRI of the pituitary gland. Diagnostic tests and normal ranges are designed such that about 2-1/2% of the normal population will have an elevated IGF-I level. These patients usually suppress growth hormone with oral glucose. Nothing further need be done with exception of repeat laboratory studies in one year.

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