Aortic Dissection: A Rare Complication in Acromegaly
https://doi.org/10.15605/jafes.041.S1
- Author:
Zanariah Hussein
1
;
Wan Faizal Wan Rahimi Shah
2
;
Hamdan Leman
2
Author Information
1. Endocrine Institute, Hospital Putrajaya
2. Cardiac Vascular Sentral Kuala Lumpur (CVSKL)
- Publication Type:Journal Article
- MeSH:
Acromegaly;
Aortic Dissection
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):81-82
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Aortic root dilatation is not uncommon in acromegaly
as a result of persistent growth hormone (GH) excess,
causing degenerative changes in the aortic wall. Acute and
extensive aortic dissection is rare and a potentially fatal
complication.
Case:We report a 51-year-old male with acromegaly due to a
GH-secreting pituitary macroadenoma with parasellar
extension, diagnosed in 2014. As primary surgical therapy
was not recommended, he received medical therapy, initially
with monthly lanreotide depot injections and subsequently
switched to pasireotide LAR for 7 years. Following tumor
size reduction with medical therapy, he underwent transsphenoidal surgery followed by stereotactic radiotherapy
for residual tumor. Despite multimodal intervention,
growth hormone and insulin-like growth factor 1 levels
were persistently mildly elevated and required combination
medical therapy along with multiple hormone replacement
therapies with thyroxine, hydrocortisone, and testosterone
for panhypopituitarism. Both hypertension and diabetes
were well controlled on treatment.
In December 2025, he presented with sudden, severe central
chest pain and rapidly progressive left lower limb weakness.
Imaging studies with computed tomography aortography
and lower limb angiogram detected an Extensive Type A
Aortic Dissection with entry point proximal to the origin
of the coronary arteries, extending to the right common
carotid, internal and external carotid arteries, and distally
into the left common iliac, proximal internal and external
iliac arteries, which were completely thrombosed.
He underwent emergency aortic dissection repair with
hemi-aortic arch replacement of the ascending aorta and
repair of perforated right coronary sinus wall, with two
vessel CABG and lower limb femoral-femoral bypass.
Postoperatively, he required prolonged ventilation and
intensive care unit care due to multiple complications:
pericardial and pleural effusions, repeated left lower
limb thrombosis requiring left popliteal embolectomy,
and embolic stroke of the right internal carotid artery and
posterior cerebral artery with subsequent hemorrhagic
transformation. He continued to recover well with
intensive physiotherapy and acupuncture and is now able
to ambulate independently
Conclusion:Cardiovascular surveillance with regular echocardiogram
and specific monitoring for aortic dilatation is important in
uncontrolled acromegaly. Consideration for surgical intervention in selected cases may be necessary to prevent acute
dissection.
- Full text:2026080413523602062EP_A113.pdf
