Hebah Alhumaidi: No financial relationships to disclose
Background: Acromegaly is a rare disease caused by excess growth hormone (GH) release, usually from a somatotroph pituitary adenoma. Association between acromegaly and hearing loss (HL) has been demonstrated by different studies. Sensorineural hearing loss (SNHL) is the most common type of HL associated with acromegaly. Conductive and mixed HL can also occur. Different mechanisms of HL were suggested in acromegaly. Excessive GH and Insulin like Growth Factor 1 (IGF-1) are thought to cause temporal bone hypertrophy and pressure on the acoustic nerve through narrowing of the internal auditory meatuses. Also, inferior pituitary tumor invasion of the epipharynx with effect on the Eustachian tubes was suggested as a cause of HL in some studies.
Case presentation: A 28-year-old female presented to the audiology clinic for evaluation of HL and headaches of 4 months duration. Her family mention that she was hard of hearing for around 5 years but this has significantly worsened over the months prior to the visit. After evaluation, a diagnosis of bilateral asymmetrical SNHL was made. Brain imaging revealed a pituitary tumor that was further evaluated with a pituitary MRI. This showed a left sided mixed solid and cystic pituitary tumor measuring 8 x 4 x 6 mm with no compression on the optic chiasm. She was referred to Endocrinology for further workup. Her past medical history was notable for obesity. No other significant past medical or surgical history. She was on Tirzepatide 2.5 mg weekly for the 3 months prior to the visit. She was mostly bothered by HL and headaches. She also reported increase in shoe size by 2 sizes over the past 10 years as well as fatigue, increased sleepiness, constipation and cold intolerance of 3 months duration. She denied vision changes, changes in facial features or the size of her hands, muscle weakness, irregular menstrual cycle, galactorrhea or purple striae. On exam her BMI 28.4, BP 128/84. She had no features of acromegaly. Rest of exam was unremarkable. Lab tests showed IGF-1 117 (28-85) nmol/L. FT4 5.9 (7.9-16) pmol/L with normal TSH. Repeated FT4 8.6 pmol/L. Prolactin 682 (71-568) mIU/L, repeated prolactin 486 mIU/L. Morning cortisol, ACTH, 1 mg dexamethasone suppression test were normal. HBA1C was 5.7%. Complete metabolic panel was unremarkable.
Oral Glucose Tolerance Test (OGTT)
Glucose (mmol/L) GH (ng/ml) 0 min 5.8 10.645 30 min 7.9 19.299 60 mins 5.6 14.922 90 min 5.0 16.472 120 mins 4.5 21.706
Results showed a paradoxical rise in GH after oral glucose load which is highly suggestive of acromegaly. She was referred for transsphenoidal surgery.
Conclusion: We present a young female with bilateral SNHL as the presenting symptom of acromegaly. Our aim is to raise awareness of this atypical presentation of acromegaly and to encourage further investigation of pituitary tumors in patients with SNHL in the right clinical scenario.
*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*
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