title: Acromegaly presenting as hirsuitism: Uncommon sinister aetiology of a common clinical sign.
abstract: Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36), features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone (39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml), elevated testosterone (0.91 ng/ml, normal <0.8) and normal dehydroepiandrosterone sulphate (DHEAS) (284 mcg/dl, normal 35-430 mcg/dl) along with polycystic ovaries on ultrasonography lead to diagnosis of associated PCOS. She was also diagnosed to have diabetes. This case presentation intends to highlight that hirsuitism may rarely be the only prominent feature of acromegaly. A lookout for subtle features of acromegaly in all patients with hirsuitism and going for biochemical evaluation (even at the risk of investigating many patients of insulin resistance and acromegloidism) may help us pick up more patients of acromegaly at an earlier stage thus help in reducing disease morbidity.
authors.affiliation: Department of Endocrinology and Metabolism, IPGMER and SSKM Hospital, Kolkata, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Jain
authors.forename: Deep
authors.initials: D
authors.lastname: Dutta
authors.forename: Ks
authors.initials: K
authors.lastname: Shivaprasad
authors.forename: Indira
authors.initials: I
authors.lastname: Maisnam
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
authors.forename: Satinath
authors.initials: S
authors.lastname: Mukhopadhyay
authors.forename: Subhankar
authors.initials: S
authors.lastname: Chowdhury
keywords: growth hormone; hirsutism; pituitary adenoma; polycystic ovarian syndrome
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