ACROMEGALIC CARDIOMYOPATHY IN AN OLDER ADULT: A CASE REPORT AND A REVIEW OF DIAGNOSTIC AND THERAPEUTIC APPROACHES

Abstract

Acromegalic cardiomyopathy is classified as an endocrine cardiomyopathy. Acromegaly is characterized by the hypersecretion of Growth Hormone (GH) and its peripheral mediator, Insulin-like Growth Factor 1 (IGF-1). The etiology in the majority of cases is a pituitary adenoma. Chronic elevation of circulating GH and IGF-1 levels affects cardiomyocyte growth, myocardial contractility, and triggers various indirect mechanisms culminating in cardiomyopathy. The clinical phenotype typically presents as hypertrophic cardiomyopathy; however, without hormonal control, it may progress to a dilated cardiomyopathy phenotype with reduced ejection fraction. In this article, we report a clinical case in an older patient presenting with dyspnea. Based on clinical and diagnostic findings, the patient was diagnosed with acromegaly secondary to a pituitary adenoma, complicated by heart failure with reduced ejection fraction (HFrEF). Management included diuretics for decongestion and optimization of Guideline-Directed Medical Therapy (GDMT), with planned pituitary tumor resection upon stabilization of heart failure. However, the patient declined surgical intervention