Acromegaly is a syndrome caused by growth hormone (GH) hyper-secretion. However, some patients can present normal or near normal levels of GH, difficulting diagnosis. We report an acromegalic patient with normal levels of GH and negative imaging at initial investigation. Acromegaly was confirmed by dynamic tests (glucose tolerance test and GH-TRH), and RMI was suggestive of a microadenoma. The patient was submitted to a transesphenoidal pituitary surgery and imunohistochemistry study, corroborating the diagnosis of acromegaly. Dynamic tests performed after surgery evidenced normal GH regulation. Considerations on the diagnosis of acromegaly were also done, emphasizing the importance of continuing the investigation whenever clinical suspicion persists, even though the initial tests are within the normal range.
Acromegaly; Normal basal GH; Hipófise tumor; Transesfenoidal surgery
