UNFAMILIAR PRESENTATION OF ACROMEGALY WITH NEUROFIBROMATOSIS AND HYPER PROLACTONEMIA

Abstract

40 yrs old female presented since  the age of 30 yrs with acral enlargements (hands and feet) Fig.1, bony promineneces of face ( frontal bossing) with wide gap between the teeth of lower jaw, oily skin,  decreased distant vision in both eyes, irregular menses and cutaneous nodules on left forearm ,  lower back (2x2 cm) and OA changes in both knees ( Fig.  1), dorsal kyphosis , increased size of  fingers and toes, coarse facial features with history of galactorrhoea and snoring.  No past history of diabetis, hypertension, asthama, tuberculosis, seizures.  Physical findings include pitting edema of feet, wrinkles on forehead, 2 x 2 cm mobile subcutaneous nodules over left forearm and lower back ( circled ones Fig.  1).  Pulse rate 88 per minute,blood pressure 190/110 mm.Hg.  Cardiac examination revealed forcible apex beat.,  Respiratory system and abdomen examinations were normal.   Genu valgum deformity of both knees (Fig.  1) present.  Hirsuitism score 18/36.  Clinical diagnosis of acromegaly, galactorrhoea, hirsuitism, hypertension and diabetis made.