“Overgrowth: Missing a Tumor” Acromegaly without Imaging Evidence of Pituitary Adenoma and No Ectopic Source: A Case Report

Nicodemus Ong, Rosa Allyn Sy


Growth hormone - secreting pituitary adenomas are the cause of acromegaly in 95% of patients. In rare circumstances, a pituitary adenoma on magnetic resonance imaging cannot be found; hence, a search for an ectopic source of GH production is done. Even rarer is an acromegalic patient without an ectopic source and without imaging evidence of pituitary adenoma. We report a case of acromegaly with no evidence of a pituitary adenoma and no evidence of an ectopic source after imaging studies; who underwent medical therapy with improving biochemical and clinical parameters.


acromegaly, pituitary neoplasms, adenoma, magnetic resonance imaging, sandostatin, cabergoline, case report

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Lonser R, Kindzelski BA, Mehta GU, Jane JA Jr., Oldfield EH. Acromegaly without imaging evidence of pituitary adenoma. J Clin Endocrinol Metab. 2010;95(9):4192-6. PMCID: PMC2936064. https://doi.org/10.1210/jc.2010-0570.

Khandelwal D, Khadgawat R, Mukund A, Suri A. Acromegaly with no pituitary adenoma and no evidence of ectopic source. Indian J Endocrinol Metab. 2011;15(Suppl 3):S250-2. PMCID: PMC3183531. https://doi.org/10.4103/2230-8210.84878.

Katznelson L, Laws E, Melmed S, et al. Acromegaly: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-51. PMID: 25356808. https://doi.org/10.1210/jc.2014-2700.

Mercado M, Borges F, Bouterfa H, et al. A prospective, multicenter study to investigate the efficacy, safety and tolerability of octreotide LAR (long-acting repeatable octreotide) in the primary therapy of patients with acromegaly. Clin Endocrinol (Oxf). 2007;66(6):859-68. PMID: 17465997. PMCID: PMC1974838. https://doi.org/10.1111/j.1365-2265.2007.02825.x.

Caron PJ, Bevan JS, Petersenn, et al. Tumor shrinkage with lanreotide Autogel 120 mg as primary therapy in acromegaly: Results of a prospective multicenter clinical trial. J Clin Endocrinol Metab. 2014;99(4):1282-90. PMID: 24423301. PMCID: PMC4009579. https://doi.org/10.1210/jc.2013-3318.

Caron P, Bevan J, Petersen S, et al. Effects of lanreotide Autogel primary therapy on symptoms and quality-of-life in acromegaly: Data from the PRIMARYS study. Pituitary. 2016;19(2):149-57. PMID: 26603536. PMCID: PMC4799252. https://doi.org/10.1007/s11102-015-0693-y.

Bronstein M, Fleseriu M, Neggers S, et al. Switching patients with acromegaly from octreotide to pasireotide improves biochemical control: Crossover extension to a randomized, double-blind, Phase III study. BMC Endocr Disord. 2016;16:16. PMID: 27039081. PMCID: PMC4818908. https://doi.org/10.1186/s12902-016-0096-8.

Trainer PJ, Drake WM, Katznelson L, et al. Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant. N Engl J Med. 2000;342(16):1171–7. PMID: 10770982. https://doi.org/10.1056/NEJM200004203421604.

van der Lely AJ, Hutson RK, Trainer PJ, et al. Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet. 2001;358(9295):1754-9. PMID: 11734231.

Shimatsu A, Nagashima M, Hashigaki S, Ohki N, Chihara K. Efficacy and safety of monotherapy by pegvisomant, a growth hormone receptor antagonist, in Japanese patients with acromegaly. Endocr J.2016;63(4):337-47. PMID: 26796763. https://doi.org/10.1507/endocrj.EJ15-0619.

van der Lely AJ, Biller BM, Brue T, et al. Long-term safety of pegvisomant in patients with acromegaly: Comprehensive review of 1288 subjects in ACROSTUDY. J Clin Endocrinol Metab. 2012;97(5):1589–97. PMID: 22362824. https://doi.org/10.1210/jc.2011-2508.

Carroll P, Jenkins P. Acromegaly. In: De Groot L Chrousos, Dungan K, et al, ed, 2016. Retrieved from http://www.endotext.org/chapter/acromegaly/. Bookshelf ID: NBK278943. PMID: 25905160.

Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: A meta-analysis. J Clin Endocrinol Metab. 2011;96(5):1327-35. PMID: 21325455. https://doi.org/10.1210/jc.2010-2443.

Freda PU, Reyes CM, Nuruzzaman AT, Sundeen RE, Khandji AG, Post KD. Cabergoline therapy of growth hormone and growth hormone/prolactin secreting pituitary tumors. Pituitary. 2004;7(1):21-30.PMID: 15638294.