Epiphora and proptosis as a presenting complaint in acromegaly: Report of two cases with review of literature
A 28-year-old female patient presented with the complaints of watery discharge from both the eyes for the past 6 years. Watering from the eyes increased when she was exposed to sunlight and wind. This was associated with upper eyelid pain and a gradual increase in eye enlargement (right > left). She consulted an Ophthalmologist who gave her frequent courses of antibiotics and acetazolamide, but the complaint persisted. For the past 1½ years, she also experienced diminution of vision and a constant headache throughout the day, which was not even relieved by analgesics. She underwent an MRI brain and was diagnosed with pituitary macroadenoma. She was referred to neurosurgery, where a diagnosis of GH secreting tumor was made and surgery performed. She developed transient diabetes perioperatively while on steroids. After the surgery, she was referred to our endocrine unit. Interrogation revealed that she had noticed a gradual weight gain, enlargement of feet (left > right) and coarsening of facial features over past few years. She had been amenorrheic for the past 8 years, after the last child birth. She had been taking thyroxine and steroid supplements post-surgery.\nExamination revealed a 156.5 cm tall, 52.4 kg female with a muscular built and blood pressure-150/80 mm Hg. There was frontal bossing, prominent jaw and bulbous lips. Bilateral hand and feet enlargement along with increased heel pad thickness was noted. Galactorrhea was present. There was swelling of both the upper eyelids and right lower eyelid and proptosis of the right eye []. Investigations revealed normal hemogram, liver and kidney function tests. Her TFTs were normal on thyrox 75 μg. Morning cortisol after stopping steroids for 1 day was 3.6 μ/dl. LH/FSH and estradiol levels (0.07 mIU/ml, 0.50 mIU/ml and 4.1 pmol/l (respectively) were suggestive of hypogonadism. Prolactin levels were 21.7 ng/ml. Post-operative GH levels were high (301 ng/ml). Post-operative MRI brain revealed a sellar mass sized 3 cm × 3 cm × 40 cm with suprasellar extension and B/L cavernous sinus involvement.