ACTA ENDOCRINOLOGICA (BUC)

Context. Acromegaly is a rare and serious syndrome and commonly associated with pituitary neoplasm. Classic cause of acromegaly in adults is the tumors of the somatotrophs that secrete growth hormone. Cirrhosis is the end stage of chronic liver disease and commonly a cause of death. It is\r\ncharacterized by diffuse hepatic fibrosis resulting in altered construction of the lobular parenchyma with widespread connective tissue septae, circumscribed\r\nregenerative nodules of hepatocytes and anastomoses between vascular channels linking portal and central vessels.\r\nObjective. To report the simultaneous cases of acromegaly and cirrhosis.\r\nCase report. A 62-year old, male patient came to the hospital complaining of severe abdominal swelling. Laboratory and imaging findings were compatible with the\r\npresence of hepatitis B virus related cirrhosis together with acromegaly. In this case, he had high GH level but lower IGF-1 level because of hepatic failure which can\r\nimpair IGF-1 production by the liver. Definitive diagnosis was made by pituitary MR and a 1 cm in diameter tumor was\r\ndetected.\r\nConclusion. This paper showed that cirrhosis can result in a low IGF-I level in patients with acromegaly. There is no\r\nprevious report available of the in the presence of coincidental combination of acromegaly and cirrhosis in a patient.

Acromegaly is commonly associated with cardiomyopathy due to chronic overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), leading to biventricular hypertrophy, diastolic dysfunction, and in advanced cases, systolic dysfunction and heart failure. This case report presents a 42-year-old male diagnosed with acromegaly, who underwent successful resection of a pituitary macroadenoma. At diagnosis, GH was 12.0 [ng/ mL] and IGF-1 was 670 [ng/mL] (age-adjusted ULN: 218). An oral glucose tolerance test was performed; GH failed to suppress below 7.20 [ng/mL]. Despite surgical intervention, the patient experienced persistent cardiac symptoms including exertional dyspnea and breathlessness, which prompted further cardiovascular evaluation. Cardiac examinations revealed significant hypertrophy of the interventricular septum and the left ventricular anterior wall, findings confirmed by echocardiography and cardiac magnetic resonance. Remarkably, genetic analysis identified a heterozygous mutation in the MYBPC3 gene, known to cause hypertrophic cardiomyopathy. This mutation likely exacerbated the patient's cardiac condition, suggesting a compounded effect of acromegaly and a genetic predisposition to cardiomyopathy. This case underscores the importance of considering genetic factors in acromegalic patients presenting with cardiomyopathy to tailor personalized management strategies. Further research is warranted to explore the interplay between hormonal excess and genetic mutations in cardiomyopathy development.

Context. Chronic unpredictable mild stress (CUMS) has been widely shown to impact neurological disorders. Recently, growing evidence suggests that CUMS may also contribute to the development of metabolic conditions such as diabetes mellitus. Objective. This study aimed to investigate blood glucose levels and histopathological and immunohistochemical changes in the endocrine pancreas in an experimental rat model of CUMS, as well as the potential protective effects of vortioxetine (VOR) treatment. Subjects and methods. A total of 28 rats were divided into four groups. The CUMS group was exposed to random stressors once daily for six weeks. Rats in the VOR and CUMS+VOR groups received VOR treatment. The VOR and control groups were housed separately, without exposure to CUMS. At the end of the experiment, blood and pancreatic tissue samples were collected from all rats. Results. Blood glucose levels were elevated in the CUMS group compared to the other groups. Histopathological analysis revealed a reduction in insulin, amylin, and insulin receptor expression, along with a slight increase in glucagon expression and a small number of necrotic cells in the CUMS group. VOR treatment improved all these parameters. Conclusions. Our findings suggested that CUMS may contribute to endocrine pancreatic damage resembling diabetes mellitus, while VOR treatment may mitigate this effect.