SAT-089 Acromegaly In Transitions: Overlap Of Endocrine And Gender Health

Abstract Disclosure: L. Lee: None. R.C. Rajasoorya: None. Background: Acromegaly is characterized by excessive growth hormone (GH) secretion leading to insidious somatic changes. These manifestations may overlap with gender-related traits or effects of hormone therapy, potentially contributing to delayed diagnosis in transgender individuals. Clinical Case: A 51-year-old Chinese transgender woman presented with progressive coarsening of facial features, voice deepening, and enlargement of the hands over several years. She attributed these changes to the discontinuation of feminizing hormone therapy a decade earlier. Historical photographs taken eight years prior corroborated the gradual progression. On further history, she had headaches, bilateral carpal tunnel syndrome with thenar wasting, recent-onset hypertension, and a history of rectal carcinoma resection. Given the constellation of features, acromegaly was suspected. Investigations showed elevated basal GH (12.9 mU/L) with a paradoxical rise to 36.2 mU/L after a 75 g oral glucose load. IGF-1 was markedly elevated at 888.9 µg/L (NR 114-492). Other pituitary hormones were normal. Magnetic resonance imaging (MRI) identified a pituitary macroadenoma measuring 1.4 × 0.7 × 0.8 cm. She underwent successful transsphenoidal surgery, achieving biochemical remission with normalization of GH and IGF-1 levels. Postoperatively, she developed arginine vasopressin (AVP) deficiency requiring long-term desmopressin therapy. She expressed satisfaction with the reversal of acromegalic features and restoration of a more feminised appearance. Conclusion: To our knowledge, this is the first reported case of acromegaly in a male-to-female transgender individual. A prior case described a female-to-male transgender patient whose features of acromegaly were initially misattributed to gender-affirming hormonal therapy1. This case underscores the importance of maintaining a broad differential diagnosis when evaluating new somatic changes in transgender individuals. The overlap between acromegalic features and gender-related traits can obscure the clinical picture, leading to delayed diagnosis. Clinicians should remain vigilant for alternative endocrine pathologies in transgender patients to ensure timely and appropriate management. References: 1.Roerink S, Marsman D, van Bon A, Netea-Maier R. A missed diagnosis of acromegaly during a female-to-male gender transition. Arch Sex Behav. 2014;43(6):1199-1201. doi:10.1007/s10508-014-0309-z Presentation: Saturday, July 12, 2025