Acromegaly with normal growth hormone levels: response to sandostatin-LAR treatment

We report a case of acromegaly with relatively low GH secretion in a patient with GH-secreting pituitary macroadenoma. The 44-year-old male patient presented with left temporal hemianopsia and characteristic acromegalic face, but had relatively low baseline and post-glucose GH levels. IGF-1 and IGFBP-1 were elevated. Transsphenoidal surgery did not achieve clinical or biochemiacl remission, and the patient still had elevated IGF-1 levels with low GH. Histological examination of the resected tumor revealed a pituitary adenoma stained weakly for GH. The patient was treated then with monthly injections of Sandostatin-LAR, with clinical improvement and suppression of IGF-I to the normal range. This is a rare case of acromegaly without elevated GH levels, and good response to treatment with somatostatin analog, as expected in classical GH-secreting pituitary adenomas.