MON-076 From Collision to Diagnosis: How a Motor Vehicle Accident Exposed Hidden Acromegaly

Abstract Disclosure: S. Duvvuru: None. E. Luna Ceron: None. L. Kattamuri: None. L. Chozet: None. T.M. Bright: None. Background: Acromegaly is characterized by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), usually due to a pituitary adenoma. It is typically diagnosed in individuals aged 40-50, with no gender predominance. Acromegaly is uncommon in young females, often presenting with nonspecific features that can lead to delayed diagnosis. We report a case of acromegaly in a young female revealed after a motor vehicle accident (MVA). Clinical Case: A 26-year-old female involved in an MVA underwent a CT scan, which incidentally revealed a pituitary adenoma (3.0 x 2.0 x 3.2 cm). She reported a 2-year history of amenorrhea and occasional mild headaches. Endocrine evaluation showed unsuppressed GH during OGTT (fasting GH 5.6 µg/L, post-glucose 4.5 µg/L; normal <1 µg/L) and elevated IGF-1 levels (1291 ng/mL; normal 63-373 ng/mL, Z score 5.5), consistent with a GH-secreting adenoma. Prolactin levels were normal by dilution (5.6 ng/mL; normal 5-25 ng/mL), ruling out a prolactin-secreting adenoma. Hypogonadotropic hypogonadism was indicated by undetectable FSH (<0.7 mIU/mL) and LH (<0.3 mIU/mL). Central hypothyroidism was evident with low TSH (0.118 mIU/L) and free T4 (0.75 ng/dL). Morning cortisol was low (8.72 µg/dL; normal >10 µg/dL), ACTH levels were normal, and the peak cortisol after ACTH stimulation was normal (27 microg/dL, n>or=18 microg/dL). Two months later, worsening headaches and blurred vision prompted hospital admission. MRI revealed a 3.8 cm pituitary macroadenoma with suprasellar extension. She underwent a craniotomy with partial tumor resection. Postoperatively, she developed central diabetes insipidus, treated with desmopressin, as well as central hypothyroidism and adrenal insufficiency requiring levothyroxine and steroid replacement. Octreotide was initiated for acromegaly due to incomplete tumor resection. Plans were made for trans-sphenoidal surgery to address the residual tumor, followed by low-dose radiotherapy. Conclusion: Acromegaly in young females is a rare clinical case. It can present with non-specific symptoms including menstrual irregularities such as amenorrhea or oligomenorrhea, weight gain, acne which can mimic common conditions including Polycystic ovary syndrome and can be overlooked leading to significant diagnostic delays. This case emphasises that a high index of suspicion and appropriate diagnostic testing is vital in such cases for early diagnosis and prompt treatment. Presentation: Monday, July 14, 2025