Pseudoacromegaly: an unusual presenting manifestation of long-standing undiagnosed primary hypothyroidism

Pseudoacromegaly or acromegaloidism is a clinical condition characterised by physical signs suggestive of excess growth hormone (GH) but with normal functioning of the GH—insulin-like growth factor-1 (IGF-1) axis. A number of disease entities, such as pachydermoperiostitis, severe insulin resistance, familial mandibular prognathism, acromegaloid facial appearance and chronic intake of phenytoin and minoxidil, are known to be associated with pseudoacromegaly. When clinical features of acromegaly are associated with normal baseline and dynamic GH and IGF1 levels, ‘burned out’ or ‘silent’ acromegaly due to spontaneous infarction of a GH-secreting pituitary adenoma should also be considered. Long-standing severe primary hypothyroidism rarely present with skin and soft tissue changes suggestive of acromegaly and the scenario gets further complicated by the radiological evidence of pituitary enlargement potentially culminating in diagnostic …