MON-057 Growth Hormone-Secreting Pituitary Adenoma Concealed by Multiple Facial Reconstructions

Abstract Disclosure: F.P. Salvador-Badilles: None. M.B. Cating-Cabral: None. B.I. Cabral: None. Acromegaly is a condition caused by overproduction of growth hormone (GH). Characteristics include facial changes, acral enlargement, and metabolic dysfunction. This manifests gradually with ∼10 years of unrecognized clinical activity. Diagnosis can be difficult when the typical features are altered when acromegaly goes undiagnosed and the patient resorts to cosmetic surgery to correct these changes. This case presents the difficulty in diagnosing a GH secreting pituitary adenoma in the setting of multiple facial reconstructive surgeries. We report a 54-year-old female, hypertensive, who initially consulted for work up of hypercalcemia and recurrent nephrolithiasis. She was diagnosed with primary hyperparathyroidism due to a parathyroid adenoma with a concomitant multinodular goiter, then underwent subtotal thyroidectomy and parathyroidectomy. Histopathology confirmed findings of parathyroid adenoma, and incidentally, papillary microcarcinoma. Post surgery, calcium levels normalized. On follow-up after a year, she reported galactorrhea. Further review of past medical history and comprehensive review of systems revealed that for many years, she had been noticing that rings no longer fit, increased shoe size, and diagnosis of bilateral carpal tunnel syndrome. Additionally, she reported that she started to undergo multiple facial reconstructive surgeries, including 2 blepharoplasties and 3 rhinoplasties because of changes in her appearance. Despite these procedures, her nose continued to increase in size which prompted further work up. Prolactin was 82.69 ng/mL, IGF-1 was 854 ng/mL and GH was 9.97 ng/mL and remained elevated with documented hyperglycemia with oral glucose load. Cranial MRI showed a 1.7 x 1.0 x 1.0 cm mass extending to the right cavernous sinus, encasing the right internal carotid artery, and sphenoid sinus. A transsphenoidal excision of the pituitary tumor was done and histopathology showed a pituitary adenoma. Immunohistochemistry was positive for GH and prolactin. Her facial features were observed to have softened following the surgery. 6 months post excision, IGF-1 decreased to 419 ng/mL, GH decreased to 1.23 ng/mL , and prolactin decreased to 21.3 ng/mL. 4 years later, GH was 1.57 ng/mL, prolactin was 36.47 ng/mL, and repeat cranial MRI showed no tumor recurrence. The case depicts the challenge in diagnosing GH secreting pituitary adenoma in a patient with a history of multiple facial surgeries which masked the typical features of acromegaly. This emphasizes the importance of thorough clinical evaluation, complete history, and comprehensive review of systems in identifying subtle manifestations of this disorder. Immediate diagnosis and management are crucial to prevent long term effects associated with growth hormone excess. Presentation: Monday, July 14, 2025