Epiphora and proptosis as a presenting complaint in acromegaly: Report of two cases with review of literature
A 37-year-old female was referred by Ophthalmologist to our endocrine unit with a presumptive diagnosis of acromegaly. She had primary complaints of increased watering from both eyes for the past 4 years, which increased on lying down and on exposure to sunlight. There had also been gradual protrusion of both the eyes (left > right) for the past 2-3 years. She had shown to multiple ophthalmologists earlier without much respite with the therapy. She had also received ayurvedic medications with no relief. The Ophthalmologist took note of her change in physical features and referred to the endocrine unit with a presumptive diagnosis of acromegaly.\nShe had noticed changes in physical appearance with gradual changes in face, feet and hands for the past 4 years. There had also been mild generalized headache for the past 3 years. She had been amenorrheic for 7 months. She had developed hypertension 2 years back. Examination revealed an average built female with body mass index - 25.6 kg/m2. There was frontal bossing, bulbous lips, prognathism, macroglossia, thickened skin of palms and feet and skin tags on the neck. Systemic examination was normal.\nEye examination revealed axial proptosis in the left eye with normaloculor motility and visual equity in both eyes. Lacrimal gland was enlarged in both eyes (left > right) []. Schirmer's test was normal.\nLab evaluation revealed normal hemogram, liver function and kidney function tests. Fasting and postprandial blood glucose levels were in the diabetic range (201 mg/dl and 220 mg/dl respectively) and lipid profile was deranged (T. cholesterol - 208 mg/dl, high density lipoprotein - 46 mg/dl, low density lipoprotein - 122 mg/dl, very low density lipoprotein - 40 mg/dl and triglycerides - 207 mg/dl). Hormone profile showed normal thyroid function test (TFT) and cortisol. Prolactin levels were 52.4 ng/ml and S. testosterone was low with normal luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels (S. testosterone - 1.75 nmol/l, LH - 2.8 mIU/ml and FSH - 3.7 mIU/ml). Basal and post-glucose GH levels were elevated (0 h - 69.5 ng/ml, 1 h post-glucose GH - 358 ng/ml).\nMagnetic resonance imaging (MRI) brain showed a moderately enhancing sellar mass (1.6 cm × 2.2 cm × 2.3 cm) with extension into suprasellar cistern and left cavernous sinus causing left internal carotid artery encasement suggestive of pituitary macroadenoma.\nMRI orbit revealed proptosis left eye with bilateral lacrimal gland enlargement [Figure and ].