Acromegaly in the differential diagnosis of hearing loss

Acromegaly is a multifactorial neuroendocrine disease caused by hyperproduction of growth hormone (GH). In more than 95% of cases the reason of acromegaly the GH-secreting pituitary adenoma. In patients with this neuroendocrine disease, a slowly developing complex of symptom can manifest with concomitant pathological conditions, including auditory function disordersDiagnostic difficulties of acromegaly at the ambulatory stage determine the importance of doctor`s awareness in different medical specialties.

Here we demonstrate a clinical case of the improvement of the auditory function due to combined surgical and medical treatment of a patient with the pituitary macroadenoma, acromegaly and hearing loss.

Anamnesis features: a patient with an active stage of acromegaly and a pituitary macroadenoma measuring 57x35x32 mm with ante-, supra-, infra-, parasellar spread, (Knosp III(D), Knosp IV(S) noted a violation of auditory function. She was consulted by an otolaryngologist, sensorineural hearing loss on the right of the 3rd degree was diagnosed, on the left of the 1st degree. The patient underwent surgical treatment of pituitary adenoma, noted a significant improvement in auditory function in the early postoperative period. Six months later, repeated audiometry was performed, marked regression of hearing damage was noted.

The case described by us indicates the reversibility of a rare complication of acromegaly — hearing loss and the importance of an interdisciplinary approach in the management of patients with this pathology.

1. Pankratova EA, Shprakh ZS. Somatostatin receptors: localization and imagining methods (review). Russian Journal of Biotherapy. 2022;21(1):10-20. (In Russ.). doi: https://doi.org/10.17650/1726-9784-2022-21-1-10-20

2. Abreu A, Tovar AP, Castellanos R et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary. 2016;19(4):448-457. doi: https://doi.org/10.1007/s11102-016-0725-2

3. Aydin K, Ozturk B, Turkyilmaz MD, et al. Functional and structural evaluation of hearing in acromegaly. Clin Endocrinol (Oxf). 2012;76(3):415-419. doi: https://doi.org/10.1111/j.1365-2265.2011.04209.x

4. Cherian KE, Kapoor N, Mathews SS et al. Endocrine glands and hearing: auditory manifestations of various endocrine and metabolic conditions. Indian J Endocrinol Metab. 2017;21(3):464-469. doi: https://doi.org/10.4103/Ijem.Ijem_10_17

5. Tabur S, Korkmaz H, Baysal E, et al. Auditory changes in acromegaly. J Endocrinol Invest. 2017;40(6):621-626. doi: https://doi.org/10.1007/S40618-016-0602-X

6. Dedov II, Molitvoslovova NN, Rozhinskaia LI, Mel’nichenko G.A. russian association of endocrinologists national practice guidelines (clinical signs, diagnosis, differential diagnosis, treatment). Acromegaly. Problems of Endocrinology. 2013;59(6):4-18. (In Russ.). doi: https://doi.org/10.14341/probl20135964-18

7. Lee JW, Bance ML. Hearing loss. Pract Neurol. 2019;19(1):28-35. doi: https://doi.org/10.1136/practneurol-2018-001926

8. Pilecki W, Bolanowski M, Janocha A, et al. Assessment of brainstem auditory evoked potentials (BAEPs) in patients with acromegaly. Neuro Endocrinol Lett. 2008;29(3):373-378.

9. Kuan EC, Peng KA, Kita AE, et al. Acromegaly: otolaryngic manifestations following pituitary surgery. Am J Otolaryngol. 2015;36(4):521-525. doi: https://doi.org/10.1016/J.Amjoto.2015.03.001

10. Andersen M, Hagen C, Frystyk J, et al. Development of acromegaly in patients with prolactinomas. Eur J Endocrinol. 2003;149(1):17-22. doi: https://doi.org/10.1530/eje.0.1490017

11. Teixeira L, Silva I, Sampaio A, et al. Hearing Loss in Acromegaly - A Review. Int Arch Otorhinolaryngol. 2018;22(03):313-316. doi: https://doi.org/10.1055/s-0037-1603619

12. Nachtigall LB. Acromegaly diagnosed in a young woman presenting with headache and arthritis. Nat Clin Pract Endocrinol Metab. 2006;2(10):582-587. doi: https://doi.org/10.1038/ncpendmet0301

13. Mercado M, Ramírez-Rentería C. Metabolic complications of acromegaly. Front Horm Res. 2018;(49):20-28. doi: https://doi.org/10.1159/000486001