GC is a 34-year-old woman who initially presented at age 19 with amenorrhea of six months duration and headaches of 2 months duration. She presented complaining of the need to purchase larger shoes almost every other year for the last couple of years due to increased foot size. Also, a close friend, whom he hadn't seen in almost a decade, commented that his appearance had noticeably changed (ie, coarser) since last they met, as they were looking at old photographs. This coupled with feeling fatigue and slight joint pain led GC to seek medical attention.Within the previous month she had also experienced visual changes.Which is the most likely diagnosis?
her fasting plasma GH level was 54 (post-OGTT) and the plasma IGF-I level was 902 Further evaluation of the patient by MRI indicated that a macroadenoma was present around the pituitary. Since the patient was experiencing visual changes, a visual field test was performed. Visual field tests revealed that GC was experiencing a decrease in her visual fields in both eyes.
Symptoms
Headache,Vision loss ,Muscular weakness ,Back pain ,Limb pain ,Sweating ,Amenorrhea ,Polydipsia ,Polyuria
Signs
Exaggerated supraorbital ridges ,Exophthalmos
Enlargement of: Hands and Feet ,Mandible (separation of teeth) ,Nose, Lips and Tongue
Bitemporal hemianopsia to blindness
Weight gain ,Hypertension ,Cardiomegaly ,Hepatomegaly ,Hyperthyroidism ,Goiter
Thyrotoxicosis ,Diabetes Insipidus
Labs
Elevated plasma Growth Hormone (in active stage)
Increased urinary 17-ketosteroids
High serum inorganic Phosphate
Elevated Alkaline Phosphatase
Hyperglycemia ,Glycosuria
Management (가능하면 수술이 매우 중요함,tumor growth가 매우 빨라서)
Transphenoidal surgery ,Radiation Therapy ,Bromocriptine
