Acromegaly: Diagnostic and Therapeutic Management Challenges in Senegal

Introduction: The management of acromegaly faces significant challenges due to the need for precise diagnosis, individualized treatment strategies, and continuous monitoring. We present two case reports illustrating the diagnostic and therapeutic management difficulties of acromegaly in sub-Saharan Africa. Case Reports: Case 1 involved a 65-year-old retired female teacher with a 10-year history of bilateral knee osteoarthritis admitted for hypertension management. Clinical examination revealed typical dysmorphic syndrome and grade II hypertension. Plasma GH and IGF-1 levels were elevated at 17 ng/mL (normal < 4.7) and 544 ng/mL (normal: 32 - 238), respectively. Brain MRI showed no hypothalamic-pituitary abnormalities. Medical treatment with octreotide was proposed but could not be administered due to unavailability and high cost (480,000 CFA francs/month). Case 2 involved a 51-year-old male with a history of somatotroph adenoma resection 10 years prior, presenting with global heart failure and dysmorphic syndrome. GH and IGF-1 levels were 45.18 ng/mL (normal < 4.77) and 615 ng/mL (normal: 32 - 238), respectively. Pituitary MRI revealed a macroadenoma. Somatostatin analogs were financially inaccessible, and the patient died 4 months after presentation. Conclusion: These observations highlight two critical areas requiring improvement in acromegaly management strategies in sub-Saharan Africa: first, the use of advanced imaging modalities such as FET-PET/MRI and ¹¹C-methionine PET when conventional MRI is inconclusive; second, improving accessibility to somatostatin analogs and other specialized treatments to prevent irreversible complications.