Antipsychotic Medication Use Delays Diagnosis of Acromegaly
نویسندگان
چکیده
Abstract Background: Elevated prolactin level from use of antipsychotic medication masked the diagnosis acromegaly. Clinical Case: A 29-year old woman presented with galactorrhea, metrorrhagia, menorrhagia, 50 lb. weight gain, hirsutism, insomnia, and breast engorgement for one year. She was evaluated by gynecology treated a combination estrogen/progesterone pill, then switched to patch. For several years she had been on haloperidol various phenothiazine medications paranoid schizophrenia. Initial evaluation included elevated 94.46 ng/ml (5.2-26.25 ng/mL). Differential PCOS versus induced hyperprolactinemia considered. Patient started metformin referred nutrition management. MRI scan ordered her primacy care physician revealed 13 x 12 10 mm pituitary mass intrinsic mixed density homogenous enhancement. Visual field testing no deficits. On further testing: IgF-1 432 (53-331 ng/ml), TSH 0.85 uIU/mL (0.35-4.94 IUI/ml), ACTH 22 pg/mL (6-50 pg/ml), cortisol 7.7 ug/dl (4.3-22.4 mcg/dl). stalk compression functioning adenoma considered cabergoline initiated after seen neurosurgery declined surgical intervention. noncompliant cabergoline. Surveillance over next two showed increase in tumor size or change hormone levels. lost follow up year increased diaphoresis swelling hands. Prolactin three decreased 50.59 ng/mL 639 ng/ml. endocrinology. Oral glucose tolerance test did not suppress growth below 1.9 Her suppressed 0.1 mcg/dl 1 mg dexamethasone. Acromegaly confirmed. neurosurgical scheduled transsphenoidal hypophysectomy. failed arrive surgery. Repeat five 16 20 1011 Octreotide LAR monthly initiated. After months injections: 69.36 ng/ml, 778 visual mild constriction superior inferior temporal fields. procedure but follow-up. Conclusion: Elevation levels conjunction schizophrenia early this patient.
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ژورنال
عنوان ژورنال: Journal of the Endocrine Society
سال: 2021
ISSN: ['2472-1972']
DOI: https://doi.org/10.1210/jendso/bvab048.1170