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

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


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.


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Author Biographies

Nicodemus Ong, Department of Internal Medicine, Cardinal Santos Medical Center
IM Resident
Rosa Allyn Sy, Endocrine, Metabolic and Diabetes Section, Cardinal Santos Medical Center


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.

How to Cite
Ong, N., & Sy, R. A. (2017). “Overgrowth: Missing a Tumor” Acromegaly without Imaging Evidence of Pituitary Adenoma and No Ectopic Source: A Case Report. JAFES , 32(2), 173. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/419
Case Reports