A 52-year-old male was di...

A 52-year-old male was diagnosed with acromegaly at the age of 30 after a general surgeon noticed characteristic physical changes during an assessment for abdominal pain. The patient had experienced gradual weight gain and enlargement of his hands and feet over four years leading up to the diagnosis. The diagnosis of acromegaly was confirmed based on a high baseline growth hormone (GH) level of 181 IU/L, which did not decrease as expected during an oral glucose tolerance test (OGTT). A pituitary CT scan revealed a sizable tumor in the pituitary fossa, extending slightly into the suprasellar region. The optic pathway was not affected. The tumor displayed varying densities and showed some enhancement. Additional assessments of pituitary function indicated insufficient cortisol response during an insulin tolerance test (ITT). The patient's baseline cortisol level was 459 nmol/L, but it did not rise appropriately despite inducing hypoglycemia. His prolactin (PRL) level was 524 IU/L (normal: <600 IU/L), thyroid function was normal (TSH: 0.84 mIU/L, total T4: 118 nmol/L), and gonadotropins (FSH: 14 IU/L, LH: 10 IU/L) were slightly elevated. Unfortunately, there is no available information regarding the patient's testosterone level before the operation. Given the inadequate cortisol response to the ITT, the patient began taking oral hydrocortisone for replacement therapy.