Fig. 1Chest X-ray and echocardiogram findings showed marked cardiomegaly and left ventricle (LV) hypertrophy. (A) Marked cardiomegaly was detected on chest X-ray. (B) Echocardiogram showed an enlarged left atrium (LA) and LV with concentric LV hypertrophy.
Fig. 2Clinical manifestations and radiographic findings showed the distinguishing features of acromegaly. (A) Jaw enlargement and frontal bone protrusion. (B) Soft tissue overgrowth of the hand (black arrow) compared with a normal adult hand (white arrow). (C) Soft tissue overgrowth of the heel pad in a foot X-ray.
Fig. 3Magnetic resonance imaging of the sella showed a suspicious 5-mm linear shape delayed enhancing lesion at the midline to the left side of the pituitary gland (arrow).
Fig. 4(A, B) Fundoscopic findings showed cotton wool patches and hemorrhage on both retinae.
Fig. 5Pathological findings of the pituitary tumor identified it as a growth hormone (GH)-secreting adenoma. (A) A pituitary adenoma in the pituitary gland (H&E stain, ×200). (B) Immunohistochemical staining of the pituitary tumor tissue showed that tumor cells were uniformly positive for GH (×400).
Table 1The Results of Echocardiography before and after Pituitary Tumor Removal
![enm-30-395-i001.jpg]()
Variable |
At admission |
3 wk after antihypertensive treatment |
6 mo after tumor removal |
Normal range |
IVSd, cm |
1.3 |
1.3 |
1.2 |
0.6-0.9 |
LVPWd, cm |
1.8 |
1.8 |
1.3 |
0.6-0.9 |
LVMI, g/m2
|
252.8 |
252.8 |
96.75 |
56-78 |
EF, % |
25 |
66 |
73 |
≥55 |
Table 2Dynamic Test of Growth Hormone Test
![enm-30-395-i002.jpg]()
Variable |
Time, min |
0 |
30 |
60 |
90 |
120 |
GH suppression test after 75-g glucose loading before surgery |
|
|
|
|
|
Glucose, mg/dL |
145 |
196 |
261 |
280 |
331 |
GH, ng/mL |
3.93 |
6.19 |
4.12 |
3.85 |
2.73 |
TRH stimulation test before surgery |
|
|
|
|
|
GH, ng/mL |
1.92 |
17.20 |
3.90 |
1.87 |
1.35 |
TSH, µIU/mL |
4.79 |
21.31 |
18.03 |
14.44 |
13.60 |
Prolactin, ng/mL |
5.5 |
31.6 |
26.5 |
18.2 |
15.4 |
GH suppression test after 75-g glucose loading after surgery |
|
|
|
|
|
Glucose, mg/dL |
89 |
157 |
258 |
220 |
211 |
GH, ng/mL |
0.57 |
0.36 |
0.17 |
0.15 |
0.18 |
Table 3Dynamic Test of GH Test: Serial Follow-up Levels of GH and IGF-1 after Pituitary Tumor Removal
![enm-30-395-i003.jpg]()
Variable |
7 wk |
5 mo |
9 mo |
13 mo |
16 mo |
25 mo |
29 mo |
GH, ng/mL |
0.38 |
0.40 |
0.11 |
0.11 |
0.12 |
0.11 |
0.05 |
IGF-1, ng/mL |
295.4 |
249.5 |
268.1 |
373.2 |
226.2 |
291.9 |
214.6 |