The oral glucose growth hormone suppression test is commonly used in the clinical diagnosis of acromegaly, but its results can be influenced by a variety of factors. This case report discusses a patient with a pituitary tumor and concurrent liver cirrhosis, highlighting the complexities in interpreting test results under such conditions. The patient, a 54-year-old male, presented with blurred vision as his primary complaint. Notably, the physical examination revealed no changes in facial features, no enlargement of hands or feet, and no other symptoms typically associated with acromegaly, which might otherwise suggest excessive growth hormone activity. Magnetic Resonance Imaging (MRI) of the pituitary gland indicated that the gland was within normal size parameters, but a small low-intensity lesion mea-suring approximately 3 mm×2 mm identified. This finding was consistent with a pituitary microadenoma. The patient's fasting growth hormone levels were significantly elevated at 8.470 μg/L, compared with the normal range of less than 2.47 μg/L. Conversely, fasting insulin-like growth factor-1 (IGF-1) levels were notably low, recorded at 41 and 52 μg/L, whereas the normal range for a person of his age was between 87 and 234 μg/L. Other pituitary hormones, including those regulating the thyroid, adrenal cortex, and sex hormones, were found to be within normal ranges. Despite this, during the glucose growth hormone suppression test, an abnormal elevation of growth hormone was observed. To investigate further, the patient was administered branched-chain amino acids, and the suppression test was repeated. However, the abnormal elevation of growth hormone persisted, indicating a failure to normalize the response. Given the patient's lack of clinical signs typically associated with elevated growth hormone secretion, the history of liver cirrhosis became a significant consideration. The disparity between elevated growth hormone levels and reduced IGF-1 levels suggested that the pituitary lesion was a non-functional adenoma rather than a source of excess hormone production. Consequently, it was concluded that the abnormal response of growth hormone to the glucose suppression test was likely related to the patient's liver cirrhosis. In addition to chronic liver disease, various other conditions could influence the results of the oral glucose tolerance growth hormone suppression test. According to the literature, factors such as puberty, diabetes, anorexia nervosa, and protein malnutrition could also affect test outcomes. These conditions could cause similar abnormalities in growth hormone dynamics, complicating the diagnosis. Therefore, clinicians must be vigilant and consider these potential influences when interpreting test results.For an accurate diagnosis of acromegaly, it is essential to combine clinical symptoms, detailed medical history, and imaging studies. The presence of conditions like liver cirrhosis should prompt careful interpretation of the test results, ensuring that other contributing factors are not overlooked. This comprehensive approach is crucial to avoid misdiagnosis and to ensure that appropriate treatment strategies are implemented based on a thorough understanding of the patient's overall health status.
Humans ; Male ; Middle Aged ; Pituitary Neoplasms/blood* ; Liver Cirrhosis/blood* ; Adenoma/blood* ; Human Growth Hormone/blood* ; Insulin-Like Growth Factor I/metabolism* ; Acromegaly/etiology* ; Magnetic Resonance Imaging

Managing a patient with both pituitary hypersecretory and hyposecretory manifestations may be perplexing. We report a 14-year-old female who presented with weight gain, polyuria and polydipsia. Biochemical results were consistent with Cushing disease with central diabetes insipidus. Pituitary magnetic resonance imaging showed right adenoma with stalk thickening. The immunohistochemistry staining of both adenomas was positive for adrenocorticotropic hormone, thyroid stimulating hormone, growth hormone and luteinizing hormone. Postoperatively, the patient developed panhypopituitarism with persistent diabetes insipidus. The coexistence of double adenomas can pose diagnostic and management challenges and is a common cause of surgical failure. Intraoperative evaluation is important in the identification of double or multiple pituitary adenomas in a patient presenting with multiple secretory manifestations.
Pituitary ACTH Hypersecretion ; Cushing disease ; Diabetes Insipidus

Coronavirus disease 2019 (COVID-19) caused unprecedented disruptions in the lives of people, inducing a change in social behavior because of quarantine and physical distancing measures for health safety. It greatly affected not only the general population but also the healthcare system, forcing healthcare providers and consumers to adjust from the traditional mode of in-person consultation to telemedicine to enable safe and prompt delivery of adequate and efficient patient care. A 35-year-old female was diagnosed with acromegaly secondary to pituitary macroadenoma, presenting as a 10-year history of weight gain, amenorrhea, hand and feet enlargement, coarse facial features, and bilateral vision loss. Patient then underwent craniotomy, right petrosal cranialization of frontal sinus, and tumor excision during the height of the pandemic in a COVID-19 referral center. Post-operatively, she was assisted in all activities of daily living. She was discharged after a few days of in-patient rehabilitation in order to decrease risk of contracting COVID-19. Telerehabilitation was then done using both asynchronous and synchronous methods while the patient stayed at home. Given the patient’s functional and visual disabilities, it was a challenge to do the traditional telerehabilitation techniques that highly rely on intact visual senses. We hereby share our experiences in providing virtual care amid these challenges towards achieving the patient’s optimal rehabilitation goals.

Objective: This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia. Methodology: This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained. Results: Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%). Conclusion This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.
acromegaly ; treatment outcomes

This paper discussed the guiding significance of "disease-syndrome-symptom" mode in FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) for dealing with ovulation disorder infertility caused by hyperprolactinemia(HPRL). FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) concentrates on the disease entities, main symptoms, pathogenesis, and syndrome differentiation, based on which the prescriptions are prescribed. This reflects the "disease-syndrome-symptom" mode, with the core lying in the "combination of disease with syndrome". The contained Discussion on Menstruation Regulation(Tiao Jing Pian) and Discussion on Getting Pregnant(Zhong Zi Pian) have important reference significance for later doctors in the diagnosis and treatment of inferti-lity, and many prescriptions are still in use due to good effects. It is believed in traditional Chinese medicine(TCM) that HPRL results from kidney deficiency and liver depression, among which kidney deficiency is the main cause. Liver depression accelerates the onset of HPRL, so the kidney-tonifying and liver-soothing herbs were mainly selected. The "disease-syndrome-symptom" mode in FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) sheds enlightenment on the diagnosis and treatment of ovulation infertility caused by HPRL, in that it is not confined to disease entity and syndrome type. The integration of "disease-syndrome-symptom" highlights the main complaint of patients and emphasizes the main pathogenesis, thus giving full play to the overall advantage of syndrome differentiation. For multiple diseases in FU Qing-zhu's Obstetrics and Gynecology(FU Qing-zhu Nyu Ke) such as infertility due to liver depression, infertility due to obesity, delayed menstruation, and irregular menstruation, although the typical lactation symptom of HPRL is not mentioned, the medication can still be determined according to the chief complaint, syndrome type, and symptoms and signs, making up for the defects of excessive reliance on serum biochemical indicators in modern Chinese medicine. We should learn its diagnosis and treatment thoughts of paying attention to liver, spleen, kidney, and heart, holism, and strengthening body resistance to eliminate pathogenic factors.
Female ; Gynecology ; Humans ; Hyperprolactinemia/drug therapy* ; Infertility ; Obstetrics ; Ovulation ; Pregnancy

Arrhythmias, Cardiac ; Genetic Diseases, X-Linked/genetics* ; Gigantism/genetics* ; Heart Defects, Congenital/genetics* ; Humans ; Intellectual Disability/genetics* ; Male ; Neuroblastoma

Hyperprolactinemia(HPRL) is one of the diseases leading to anovulatory infertility, which is a refractory gynecological disease and seriously affects female reproductive function. Professor MA Kun has summarized his experience in clinical and scientific studies for many years. And believes that kidney deficiency is the pathogenesis of HPRL and blood stasis is the dominant pathological manifestation of HPRL and can promote the progress of the disease. In view of this, Professor MA Kun took the therapy of kidney-tonifying and blood-activating as the principle for treating anovulatory infertility caused by HPRL, with soothing the liver and promoting Qi as adjuvant therapies. She has also summarized and refined the prescriptions for tonifying kidney and inducing ovulation, which have a remarkable clinical efficacy.
Drugs, Chinese Herbal/therapeutic use* ; Female ; Humans ; Hyperprolactinemia/drug therapy* ; Infertility, Female/etiology* ; Kidney ; Medicine, Chinese Traditional

ABSTRACT Acromegaly is a devastating chronic slowly progressive disease. Its early diagnosis is a challenging issue that necessitates clinical suspicion of signs and symptoms as a first step. This report introduces an unusual early sign in the oral cavity that lead to the early diagnosis of an acromegaly case. A case of a healthy 40-year-old male patient presented with progressively growing multiple hard swellings in the upper and lower jaws. Clinical examination revealed bony hard multiple small spiky exostosis-like swellings, located at the maxillary and mandibular alveolar bones. An array of investigations revealed a 2-mm diameter pituitary tumour in MRI of sella. To the best of the author’s knowledge, this is the first report of spiky exostosis-like growths in the alveolar bone as an early sign of acromegaly. In this case, thorough examination of oral signs and symptoms was the first step for early diagnosis and hence, better prognosis for acromegaly.
Acromegaly--diagnosis

BACKGROUND: Adult-Onset Still's Disease is a rare inflammatory disorder with an estimated incidence of 1 in 1,000,000 that presents with a rash, fever, and arthritis. Furthermore, there have only been three reported cases in the Philippines. Its presentation is similar to other more commonly encountered inflammatory disorders; however, it is the negative immunologic and serologic workup that typically distinguishes this rare specific inflammatory disorder along with the fulfillment of diagnostic criteria set by Yamaguchi and Cush. CASE: This is a case of an 18-year-old female who presented with recurrent fever, rash, and polyarthritis. The patient underwent extensive workup, but immunologic studies were negative. A consideration of Adult-Onset Stills Disease was made and along with the fulfillment of the classification criteria set by Yamaguchi and Cush, the diagnosis was clinched and the patient was started on glucocorticoid therapy where improvement of the patient's condition was noted with the resolution of the fever, rash and minimal complaints of joint pain. CONCLUSION: Adult-Onset Still’s Disease is an uncommon inflammatory disorder that confers high morbidity and disability. It commonly presents with shared clinical features among other inflammatory disorders; thus, recognition of the existence of this disease entity could pose a diagnostic dilemma. A high clinical suspicion along with negative studies and fulfillment of the diagnostic criteria avoids unnecessary workup and inappropriate management.
Autoimmune Diseases ; Joint Diseases ; Pituitary ACTH Hypersecretion

The clinical efficacy of Bushen Huoxue traditional Chinese medicine( TCM) in the treatment of hyperprolactinemia were systematically evaluated,which provided evidence-based medical evidence for the treatment of hyperprolactinemia with Bushen Huoxue traditional Chinese medicine. The randomized controlled trials on the treatment of hyperprolactinemia with Bushen Huoxue traditional Chinese medicine were comprehensively searched by computer in PubMed,EMbase,Cochrane Library,CNKI,Wan Fang,VIP,CBM and Meta-analysis was performed. The search time is from the time of self-built database to September 28,2018. A total of 816 patients with hyperprolactinemia met the inclusion criteria in 13 clinical studies. The results of Meta-analysis showed that compared with Western medicines,traditional Chinese medicine for tonifying kidney and activating blood circulation had a comparable effect in reducing prolactin and treating infertility,and had obvious advantages in improving of TCM syndromes,disease recurrence and reducing of side effects.
Drugs, Chinese Herbal ; therapeutic use ; Female ; Herbal Medicine ; Humans ; Hyperprolactinemia ; drug therapy ; Phytotherapy