MON-462 Not pheochromocytoma; A case of Acromegaly Presenting with Hypertensive Emergency

Abstract B. Zaidan: None. S. Khalid: None. T.N. Parimi: None. Background: Acromegaly is a rare clinical syndrome that results from excess growth hormone with clinical features that can be either subtle or severe (1). The most common cause of acromegaly is a pituitary tumor that causes excessive production of growth hormones (1). The mortality of acromegaly is high due to cardiovascular and respiratory complications (2). Here, we present a case of acromegaly presenting as hypertensive emergency. Case description: A 45-year-old male patient presented to the hospital with dyspnea. Medical history included CHF, primary hyperaldosteronism due to bilateral adrenal hyperplasia and CKD stage 3A. Reported medication nonadherence to eplerenone, carvedilol, chlorthalidone, and nifedipine. Initial vitals revealed a blood pressure of 197/96 mmHg, leading to ICU admission for hypertensive emergency. Hospital course complicated by encephalopathy requiring intubation, uremic pericarditis, acute renal failure requiring dialysis. Endocrinology consulted for extremely labile blood pressures. Stress dose steroids was started for intermittent hypotension. Work up was negative for pheochromocytoma. Pituitary macroadenoma 2x1.5 cm without suprasellar extension was incidentally discovered on MRI brain obtained for headache. Post-discharge, pituitary hormone evaluation revealed elevated IGF-1 at 903 ng/mL (range 52-328 ng/mL), high growth hormone level at 14.1 ng/mL. hyperprolactinemia and normal free thyroxine. Cortisol axis evaluation shown mildly elevated salivary cortisol at 0.1 and 0.13 (< 0.09 mcg/dL) with a normal ACTH level and further work up is underway. The patient was diagnosed with acromegaly and referred to neurosurgery. Conclusion: Hypertension is reported in roughly 50% of patients with acromegaly and is a poor prognostic factor for mortality. Hence, early and aggressive treatment is imperative to reduce associated cardiac morbidity and overall mortality (3). Reference: 1. Akirov A, Asa SL, Amer L, Shimon I, Ezzat S. The clinicopathological spectrum of acromegaly. Vol. 8, Journal of Clinical Medicine. 2019. 2. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management. Vol. 25, Endocrine Reviews. 2004. 3. Sharma, Morali D et al. “Cardiovascular Disease in Acromegaly.” Methodist DeBakey cardiovascular journal vol. 13,2 (2017): 64-67. doi:10.14797/mdcj-13-2-64 Monday, June 3, 2024