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Obstructive sleep apnea preceding acromegaly diagnosis
Obstructive sleep apnea may be caused by endocrine disorders such as acromegaly and hypothyroidism. Acromegaly is a benign and rare disease characterized by excessive secretion of growth hormone (GH) and insulin-like growth factor (IGF1). Acromegaly is associated with increased mortality due to cardiovascular and respiratory complications. Obstructive sleep apnea (OSA) is the most typical respiratory comorbidity. OSA diagnosis can can precede acromegaly diagnosis.
This case report an OSA patient with typical symptoms of acromegaly yet undiagnosed.
A 48 year-old male patient was referred to the outpatient sleep medicine clinic due to loud snoring, nocturnal respiratory pauses and daytime excessive sleepiness (Epworth 18/24). When asked, he mentioned that his voice became low-pitched in the last few years and that he had to cut his wedding ring twice due to increase in the diameter of his ring finger. He brought old photos which revealed that his face enlarged, his jaw protruded, his nose wings enlarged and his lip thickened. A polysomnography and serum IGF1 were requested .
The polysomnography showed severe obstructive apnea (89. 2 events/h), IGF1=843ng/ml(normal range 53-215 ng/ml). The patient was referred to the neuroendocrinology service for treatment. CPAP and and weight loss were recommended. Two months after the OSA diagnosis, the patient was using CPAP regularly (use=28/30 days; CPAP level=7cmH20 and residual AHI=0.2 events/h) . The patient reported improvement in both sleep quality and excessive daytime sleepiness (Epworth 14/24).
One must pay attention on clinical signs and symptoms of acromegaly among patients with OSA.
obstructive sleep apnea, acromegaly
Relato de Caso
FMUSP - Sao Paulo - Brasil
Marcela Yanagimori, Thais Cano, Viviane Vieira Passini, Mariana Delgado Fernandes, Cassio Batista Lacerda, Bruno Sergio Vasconcellos, Camila Bae Uneda, Geraldo Lorenzi Filho, Pedro Rodrigues Genta