Craniofacial and Radiological Features as Diagnostic Clues to Unmask Acromegaly: A Case Report

A 70-year-old female with a past medical history of type 2 diabetes mellitus (treated with insulin), hypertension, and bipolar disorder was admitted to the Intensive Care Unit after suffering cardiac arrest post-seizure. During the initial workup, CT of the head was notable for marked, diffuse calvarial thickening (~17 mm), a large sella turcica, and no evidence of pituitary apoplexy. MRI of the head showed a 1.9 cm pituitary macroadenoma. The physical examination was notable for thick facial features such as macroglossia, acrochordon, and fleshy hands - consistent with acromegaly. Insulin-like growth factor-1 (IGF-1) was elevated at 570 ng/mL (Z score: 4; normal 34-245). IGF-binding protein 3 (IGFBP-3) was elevated at 9 µg/mL (normal 3-6). However, the patient had never previously been diagnosed with acromegaly. Throughout the course of her admission, the patient required multiple bronchoscopies due to thick secretions and mucus plugging. The etiology of her respiratory failure and sudden cardiac arrest remained undetermined after a comprehensive diagnostic workup. While acromegaly typically manifests with musculoskeletal changes and endocrine abnormalities - including diabetes mellitus, hypertension, and galactorrhea - it also carries a substantial risk of secondary respiratory and cardiac complications. This report highlights the importance of early diagnosis of acromegaly, specifically in identifying, being cognizant of, and preventing respiratory and cardiac complications.