SUBCLINICAL ACROMEGALY DUE TO A PITUITARY CYSTIC SOMATOTROPH ADENOMA

Excess growth hormone (GH) secretion from a cystic sellar lesion is rare. Indeed, there have been few cases of hormone-secreting pituitary adenomas with a cystic component. We report a rare case of subclinical acromegaly that presented as a cystic sellar lesion on magnetic resonance imaging (MRI). A 34-year-old Caucasian female presented with arthralgias, diaphoresis, paresthesias, cognitive slowing, headaches, presyncope, anxiety, and depression. She underwent evaluation by multiple providers without a diagnosis. Her physical examination was reportedly normal without evidence to suggest acromegaly. While she was undergoing workup for multiple sclerosis, a brain MRI scan revealed a cystic sellar lesion measuring approximately 1.6 × 0.9 cm approaching the optic chiasm. An insulin-like growth factor 1 level was incidentally screened months later and was elevated at 823 ng/mL (reference range is 69 to 227 ng/mL). A subsequent oral glucose tolerance test reported a growth hormone level of 7.5 ng/mL at its nadir (reference range is