Continuity of care in acromegaly: Detecting and managing recurrence after surgical intervention

Abstract

Acromegaly is a rare disease being followed up by primary care team. It is usually caused by pituitary adenoma and the treatment would be resection of the tumour. But is surgical intervention the end of treatment for acromegalic patient? This case highlighted the continuity of care in a 65-year old gentleman who had been diagnosed acromegaly since the age of 31. He had undergone a transseptal transsphenoidal resection of his pituitary adenoma when he was 45-year-old. Postoperatively, there were still residual growth hormone (GH) and insulin like growth factor (IGF-1) secretions. However, during 20 years follow up after operation, despite the increasing level of GH and IGF-1, the management of acromegaly were neglected as the focus of treatment were shifted towards his other medical problem, which is diabetes and atrial fibrillation. During his latest follow up, his complaint of unspecified headache and expressed his worry regarding the recurrence of his condition. Repeated GH level showed an increase in its level and postulated the possibility of recurrent acromegaly. This case emphasizes the important of recognizing the level of GH and IGF-1 after surgical intervention in order to detect recurrence acromegaly by primary care and early referral to endocrine team.