Baylor University Medical Center Proceedings January 2014, Volume 27, Number 1 | Page 19

b

a

Figure 1. (a) CT abdomen without contrast showing a thickened pancreas with subtle haziness and strand changes in the surrounding peripancreatic fat and a
small amount of fluid in the anterior pararenal space consistent with acute pancreatitis (arrow). (b) Head MRI, sagittal view, showing a mass in the pituitary gland,
consistent with pituitary macroadenoma (arrow).

b

a

Figure 2. Pathology of resected pituitary mass. (a) Hematoxylin and eosin stain (125×) shows sheets of cells with amphophilic cytoplasm and relatively uniform
nuclei. (b) Cells stain strongly with growth hormone on immunohistochemical stain (125×).

The patient denied headaches, visual disturbances, joint pain,
recent facial morphologic changes, changes in ring, shoe, or hat
size, or sexual dysfunction. He had normal visual acuity, fields, and
color vision. Head magnetic resonance imaging (MRI) (Figure 1b)
showed a mass in the pituitary gland extending to the right side
of the sphenoid sinus (18.5 × 14.7 × 17.2 mm), consistent with a
pituitary macroadenoma. The patient underwent transsphenoidal
tumor resection; the pathologic diagnosis was pituitary adenoma,
granulated somatotrophic type (Figure 2).
DISCUSSION
It is estimated that about 40% of patients with acromegaly
develop diabetes mellitus (1). Pancreatic cell dysfunction and
insulin resistance from the antiinsulinergic effect of excess GH
January 2014

and insulin-like GF have been proposed as part of the pathogenesis (4). GH-dependent inhibition of lipoprotein lipase activity
also results in hypertriglyceridemia, the lipid abnormality most
commonly described in acromegaly (1).
The American College of Gastroenterology states that the
diagnosis of acute pancreatitis requires the presence of two
of the following three criteria: 1) characteristic abdominal
pain; 2) serum amylase and/or lipase more than three times
the upper limit of normal; and 3) CT scan findings compatible with acute pancreatitis (3). Pancreatitis secondary
to hypertriglyceridemia accounts for approximately 10% of
the cases (2), with an increased risk for acute pancreatitis
associated with severe hypertriglyceridemia (≥500 mg/dL)
(5), as in our patient.

Newly diagnosed acromegaly presenting with hypertriglyceridemic pancreatitis with normal amylase and lipase levels

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