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.
Acromegaly ; Aortic Dissection