Ectopic acromegaly due to a growth hormone-secreting neuroendocrine-differentiated tumor developed from ovarian mature cystic teratoma

Acromegaly is a clinical syndrome caused by the overproduction of growth hormone (GH) and also known as a rare disease. Clinical, biochemical, and radiological features are often indistinguishable between GH-producing hypophysis adenomas and ectopic GH-releasing hormone (GHRH)-producing tumors. A 40-year-old woman presented to us with her growing feet, hands especially fingers, and enlarging nose. Biochemical diagnosis of acromegaly was made by measuring insulin-like growth factor-1 (IGF-1) level and glucose-suppressed GH estimation. Her spot IGF-1 level was 1300 ng/ml (90–226 ng/ml). The basal GH was 30 ng/l, and 60- and 120-min GH levels after 75-g oral glucose load were 29 and 40 ng/l, respectively. Magnetic resonance imaging (MRI) of pituitary was normal. There was no pituitary adenoma or pituitary hyperplasia. Extrapituitary ectopic hypersecretion of GH or GHRH-secreting tumor search was done by high-resolution computed tomography (CT) of chest and whole abdomen. Abdomen CT revealed 9.5 × 8 cm pelvic mass, which included calcific regions and solid component. The specimen’s immunohistochemical staining with GH was positive but interestingly GHRH was negative. According to immunohistochemical staining, the patient’s diagnosis was ectopic acromegaly due to a GH-secreting neuroendocrine-differentiated tumor developed from an ovarian mature cystic teratoma. Herein, we present excellent illustration of an unusual and confusing clinical scenario of ectopic acromegaly.