1. Acromegalic cardiomyopathy: A case report
Xuan Su1, Zi Wang1, and Meng Jiang 1*
1Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Introduction:
Acromegaly is an endocrine disease with specific somatic changes due to an excess of growth hormone. The majority of cases are caused by growth hormone producing pituitary tumors. Cardiovascular complications, which can be detected even in the early stages of the disease, are considered as major contributing factors in the increased morbidity and mortality of the patients. In the present report, we describe a case of an acromegalic patient with myocardial hypertrophy and diastolic cardiac dysfunction.
Figure 1
Case presentation:
A 61-year-old women was admitted to our hospital for progressive decrease of exercise tolerance and several episodes of syncope during the last 4 months, with ECG evidence of I-II atrioventricular block and premature ventricular contraction. On physical examination, pronounced lower jaw protrusion with macroglossia and swelling of the soft tissues in the hands and feet were evident , and both lower extremities showed mild pitting edema.
The concentration of serum brain natriuretic peptide (BNP) was 1066ng/L. The main echocardiographic findings were as follows: left ventricular hypertrophy, mild systolic dysfunction and severe diastolic dysfunction. Cardiac magnetic resonance (CMR) showed: left ventricular multi-part myocardial hypertrophy, diffuse wall motion abnormalities, both atrial enlargement, a small amount of pericardial effusion. (Figure 1) Coronary angiography showed normal coronary arteries.
Hand X-ray suggested acromegaly for both hands bone hyperplasia. (Figure 2) Oral glucose tolerance test (OGTT) and growth hormone findings also suggested the diagnosis of acromegaly. (Figure 3) Cerebral magnetic resonance imaging (MRI) revealed an intrasellar mass lesion, suggestive of definitive presence of a pituitary microadenoma. (Figure 4)
From the above, the patient was diagnosed as acromegalic cardiomyopathy, then she was given somatostatin and anti heart failure treatment. For the improvement of symptoms, she discharged from hospital.
Figure 2
Figure 3
Figure 4
Conclusion:
Patients who are diagnosed having acromegaly develop a lot of cardiovascular complications such as hypertension, myocardial hypertrophy, arrhythmias, systolic and diastolic dysfunction, valvular dysfunction and heart failure. In the clinical work, we should get a comprehensive understanding of these patients’ condition to make the diagnosis early and treat them effectively.
Presented at the 3rd SCMR China Symposium, in Shanghai, China, August 4-7, 2017