Multiple Morbidities in Acromegaly With Apparently Normal Growth Hormone Levels

We present a case of acromegaly with normal growth hormone levels. The patient had markedly elevated IGF-1 and a pituitary microadenoma. He refused all modalities of treatment, and over a span of 30 years the signs and symptoms of acromegaly progressed. This case illustrates the shortcomings of growth hormone–based parameters in the diagnosis of acromegaly and the clinical importance of prolonged elevation of IGF-1. The literature on the diagnostic criteria for acromegaly and on cases of acromegaly without a significant growth hormone elevation is reviewed.