Abstract

Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Hirsutism is not considered to be a prominent feature of acromegaly A 35 year lady presented to the Endocrinology Clinic with complaints of increased facial hair, body hair and acne of 8 years duration associated with coarse facial feature(broad nose, large lip), deepening of voice, increase muscle mass . She complained of Headache since 5 years which increased since 4 months. She denied history increased ring or shoe size, diplopia/decrease vision, abdominal striae proximal muscle weakness. Examination was significant for normal blood pressure, body mass index-23.48 kg/m² acne, hirsuitism (modified Ferriman Gallwey Score-20/36), bulbous lips and woody nose (figure 1). She have deepening of voice, macroglossia, spacing of teeth in lower jaw, acral enlargement, increased muscle mass, increased sweating. Investigations were significant for elevated IGF-1 (622 ng/ml; normal: 116-384 ng/ml), basal growth hormone (32.20 ng/ml) and post glucose growth hormone (29.20 ng/ml), elevated androgens. Automated perimetry was normal. Colonoscopy revealed normal colonic mucosa. Ultrasonography abdomen revealed enlarged bilateral ovaries, presence of peripheral arranged multiple follicles. MRI brain revealed a sellar mass with significant suprasellar extension suggestive of pituitary macroadenoma.