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

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.