Successful 15-year management of a 97-year-old woman with acromegaly: a case report and review of the literature

Abstract

Background: With an increasingly aging population, the prevalence of acromegaly in the elderly is rising. The treatment goal is defined in the guidelines as “IGF-I normalized for age;” however, in the super-elderly, where physiological interindividual variability is particularly pronounced, this goal remains uniform and may require further consideration. We present a case of well controlled acromegaly in an elderly patient, experiencing a good quality of life even with mildly elevated serum growth hormone concentration. Case presentation: A 97-year-old Japanese woman was diagnosed with acromegaly since the age of 82 years on the basis of a typical appearance, intractable hypertension, and diabetes mellitus. Head magnetic resonance imaging showed a sellar tumor with a maximal diameter of 10 mm. Endocrinological examination revealed elevated serum concentrations of growth hormone and insulin-like growth factor-1 to 1.82 ng/mL and 997.1 ng/mL, respectively. Medical treatment with octreotide led to a decrease in serum growth hormone and insulin-like growth factor-1 concentrations to 1.45 ng/mL and 352.5 ng/mL, respectively. Since then, serum concentrations of growth hormone and insulin-like growth factor-1 have remained mildly elevated, and clinically, antihypertensive and oral hypoglycemic medications have become unnecessary. The patient maintains good physical condition and cognitive function without frailty. Conclusion: Although the optimal range of serum growth hormone concentration has yet to be elucidated, a disease-controlled state with mild growth hormone elevation targeting insulin-like growth factor-1 level may be acceptable as a treatment goal for elderly patients with acromegaly.