Resized

A 55 year old man complains of progressive changes in his facial appearance over the last year, as noted by his wife and co-workers. He has also gained 15 kg of weight in that time.

Further questioning reveals a history of numbness and tingling in his fingers for the last 3 months, and intermittent headaches for the past 5 months. He has also gained a shoe size since the onset of symptoms.

His medical, surgical, and family histories are unremarkable. He does not smoke, and only drinks socially.

Select Relevant Investigations
Endocrine Profile

Performed

Growth Hormone: 6.12 ng/mL (<5)
TSH, Prolactin, FSH, LH, Random Cortisol: within normal parameters
Serum IGF-1 Levels

Performed

Serum IGF-1: 245ng/mL (45-173)
GH Suppression Test

Performed

GH levels were 2.43ng/ml (normal <1ng/ml), two hours following administration of 75g glucose.
MRI Brain

Performed

The MRI shows the pituitary gland to be slightly enlarged, and asymmetrical.

Select Relevant Management
Octreotide
Transsphenoidal Surgery
Stereotactic Radiotherapy
Cabergoline