Coexistence of acromegaly and raised intracranial pressure: insights from a rare case report and literature review.

backgroundIdiopathic intracranial hypertension (IIH) is a rare condition characterized by increased cerebrospinal fluid pressure without an intracranial mass, mainly affecting overweight women of reproductive age. It commonly presents with headache, visual disturbance, and papilledema. Acromegaly is an uncommon endocrine disorder caused by a growth hormone-secreting pituitary adenoma. CASE PRESENTATION: A 24-year-old female presented to an ophthalmology clinic complaining of blurred vision and generalized headache. Clinical examination revealed coarse facial features and a deep voice, raising suspicion of an underlying endocrine disorder. Fundoscopic examination showed bilateral papilledema (grade II in the right eye, grade I in the left). Laboratory investigations showed elevated IGF-1 (508 ng/mL) and unsuppressed GH levels during an oral glucose tolerance test. Brain magnetic resonance imaging (MRI) demonstrated a 1.5 × 1.3 cm pituitary adenoma extending into the left cavernous sinus. These results led to the diagnosis of acromegaly with a pattern of raised intracranial pressure resembling IIH. Notably, headache and visual problems continued after surgery, requiring acetazolamide medication (250 mg twice daily) to control intracranial pressure.

conclusionEven in the absence of optic chiasm compression, papilledema and symptoms of raised intracranial pressure can occur in patients with acromegaly. Management of IIH generally aims to reduce intracranial pressure through weight optimization, medical therapy, or surgical intervention when indicated.