UCLA Department of Medicine Clinical Insights

Acromegaly is a rare endocrine disorder caused by excess growth hormone (GH), most commonly from a pituitary adenoma. Diagnosis is frequently delayed due to insidious onset and subtle clinical manifestations. We report a 37-year-old male who presented with fatigue and weight gain, initially prompting evaluation for hypogonadism. Laboratory testing revealed low testosterone and mild hyperprolactinemia, leading to a broader pituitary evaluation. Insulin-like growth factor-1 (IGF-1) was elevated on repeated testing, and GH failed to suppress during oral glucose tolerance testing, confirming acromegaly. Pituitary MRI demonstrated a 9 mm sellar lesion. The patient underwent transnasal transsphenoidal surgery with gross total resection. Pathology confirmed a GH-secreting adenoma. Postoperative GH levels were consistent with biochemical remission. This case highlights the importance of considering acromegaly in patients with nonspecific symptoms and minimal physical findings.