A case of rapidly progressive proliferative diabetic retinopathy in acromegaly: An alarming scenario

ABSTRACT Acromegaly usually occurs due to excessive secretion of growth hormone from somatotropinoma. GH is an anabolic hormone that also causes tissue proliferation. A 43-year-old female presented with progressive diminution of vision with multiple clinical features characteristic of acromegaly. One year ago, she was diagnosed with acromegaly due to macrosomatotropinoma and uncomplicated diabetes mellitus (DM) secondary to acromegaly. Trans-nasal trans-sphenoidal pituitary surgery was performed, followed by treatment with prednisolone and oral hypoglycemic agents, but she continued to have uncontrolled glycemia. Now, her further evaluation showed active disease with high insulin-like growth factor-1 (IGF-1) levels and non-suppressible GH with the glucose tolerance test. Imaging showed a residual tumor encasing the right internal carotid artery. On fundus examination, changes suggestive of PDR were present in both the eyes, which were not present initially. Such rapid progression cannot be completely explained by uncontrolled glycemia and needs exploration of the role of GH and IGF-1, thus also implying more frequent fundus screenings in such settings.