She Has a Big and Weak Heart

Abstract Background: Acromegaly is a rare clinical syndrome caused by excessive production of growth hormone. The incidence rate 3 to 4 cases per million people year. It sporadic disease seen in middle-aged adults. Anterior pituitary adenoma secreting the hormone (GH) most common etiology. Other causes include hypothalamic and neuroendocrine tumors. Treatment modalities surgical, radiotherapeutic pharmacological with goal reduce or remove tumor, prevent recurrences, improve comorbidities. persistent hypersecretion GH insulin-like factor-1 (IGF-1) leads an overgrowth many tissues, including connective tissue, cartilage, bone, skin, visceral organs. Cardiovascular one critical systemic complications resulting about 60% deaths. cardiovascular manifestations hypertension, cardiomyopathy (CMP), congestive heart failure, arrhythmias. Our patient presented failure dilated CMP setting undiagnosed Acromegaly. Clinical Case: 45 -year old Caucasian lady complaints worsening shortness breath, chest tightness, palpitations for month. Past medical history includes type 2 diabetes mellitus, obesity, hyperlipidemia. She was diagnosed her early 30s, AICD placement seven years ago normal cardiac catheterization three ago. On physical exam, she found have enlarged nose bibasilar crackles. Vitals were stable proBNP: 4,699 (1-150 pg/ml). ECHO revealed EF 30-35%, severely left ventricle. Cardiac showed decreased ventricular systolic dysfunction elevated LVEDP. Further workup - GH: 16 (<10 ng/ml) IGF-1: 637 (62 205 ng/ml), A1C 13.2%. Pituitary MRI 1.6 cm macroadenoma, extending right cavernous sinus border deviation stalk left. neurosurgical evaluation, considered be poor surgical candidate due underlying CMP. Currently, process getting started on oral octreotide treatment. Conclusion: captious complication leading cause mortality patients. subtle presentation results diagnostic delay 5-10 years. A careful review examination vital identify acromegalic features non-ischemic DCM. Early diagnosis prompt treatment has shown improvement function reduced mortality. This case underscores importance considering as differentials patients cardiomyopathy.