MON-881 - A Rare Case of Acromegaly Initially Diagnosed as Hypogonadism

Introduction
Acromegaly is a rare endocrine disorder primarily caused by a pituitary adenoma, resulting in excessive secretion of growth hormone (GH) and elevated levels of insulin-like growth factor 1 (IGF-1). While typical presentations include distinctive physical changes, this case highlights a unique presentation without the classic somatic alterations, underscoring the diagnostic challenges associated with atypical manifestations.

Case Presentation
A 25-year-old male presented with concerns of decreased libido, prompting initial laboratory investigations that revealed low testosterone levels. Suspecting an underlying endocrine disorder, the patient was referred to an endocrinologist for further evaluation. Subsequent imaging with magnetic resonance imaging (MRI) of the brain identified a pituitary macroadenoma. Concurrent laboratory findings showed elevated IGF-1 levels, leading to a diagnosis of acromegaly. Notably, the patient did not exhibit the characteristic physical changes typically associated with acromegaly, such as enlargement of the hands, feet, or facial features. The patient was initially diagnosed with hypogonadism instead of Acromegaly. After in depth work up, the patient was started on a somatostatin receptor ligand and received transsphenoidal surgery.

Conclusion
This case highlights the importance of considering acromegaly in the differential diagnosis, even when classic physical presentation is absent. The presentation with decreased libido and hypogonadism highlights the diverse symptomatology of acromegaly and emphasizes the need for a high index of suspicion and comprehensive endocrine work-up in atypical cases. Early recognition and diagnosis of acromegaly, regardless of the presence of traditional physical manifestations, are crucial for the timely management and prevention of long-term complications. This case underscores the significance of thorough evaluation in young patients presenting with hormonal imbalances and atypical symptoms, advocating for increased awareness among clinicians.

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