Faraz Farishta and Mohammed Salman Hadi
A 35 year old BHEL field worker presented with increased shoe size and tightness of ring, change in facial appearance, voice change, tingling and numbness in hands and snoring since 6 months. On examination his BP was 160/100, elongated head, prominent supra orbital ridges, Enlarged nose, lips, ear, widely spaced teeth, husky voice. Nape of neck was hyper pigmented. His systemic examination (including visual perimetry) was unremarkable. His Lab investigations were GH: 29.8 (0-3NG/ML), IGF: 811 (115-307 ng/mL). T3/T4/TSH/HBA1C/FBS/PLBS/Cortisol/ Prolactin-were within normal limits. USG Abdomen and Pelvis: Non obstructive left renal calculi (7 mm), borderline prostatomegaly, 2D-Echo-EF-60%, minimal septal hypertrophy. MRI brain showed pituitary adenoma. Treatment options for acromegaly were discussed with the patient. Patient was started on somatostatin analogue and referred to neurosurgery team for further management.