Nigerian Journal of Cardiology

CASE REPORT
Year
: 2019  |  Volume : 16  |  Issue : 2  |  Page : 111--112

Aortic valve regurgitation and acromegaly


Jospin Karel Bassakouahou Makani1, Meo Stéphane Ikama2, Louis Igor Kafata Ondze2, Gisele Suzy Kimbally Kaky2,  
1 Department of Cardiology, Teaching Hospital of Brazzaville, Brazzaville, Republic of Congo
2 Department of Cardiology, Teaching Hospital of Brazzaville; Marien Ngouabi University, Brazzaville, Republic of Congo

Correspondence Address:
Dr. Jospin Karel Bassakouahou Makani
Department of Cardiology, Teaching Hospital of Brazzaville, Brazzaville
Republic of Congo

Abstract

We report a case of global heart failure revealing aortic regurgitation in a 50-year-old male with acromegalic dysmorphism. The echocardiography noted a hypertrophy and dilatation of left ventricular and severe aortic regurgitation. A large pituitary adenoma was visualized using magnetic resonance imaging. Growth hormone was high.



How to cite this article:
Makani JK, Ikama MS, Ondze LI, Kaky GS. Aortic valve regurgitation and acromegaly.Nig J Cardiol 2019;16:111-112


How to cite this URL:
Makani JK, Ikama MS, Ondze LI, Kaky GS. Aortic valve regurgitation and acromegaly. Nig J Cardiol [serial online] 2019 [cited 2020 Feb 26 ];16:111-112
Available from: http://www.nigjcardiol.org/text.asp?2019/16/2/111/270690


Full Text



 Introduction



Acromegaly is a dysmorphic syndrome resulting from inappropriate secretion of growth hormone. Cardiovascular manifestations such as high blood pressure, heart failure, or rhythm disorder are possible.[1],[2] The particularity of this case is the association with aortic valve regurgitation – is that the outcome of acromegaly or a simple coincidence?

 Case Report



A 50-year-old male was admitted to the department of cardiology in the teaching hospital of Brazzaville, July 2016, for the management of global heart failure. The family history reported cancer in father and sister. He present acromegalic dysmorphism due to pituitary adenoma, diagnosed in 1994. High blood pressure occurred after ten years. Recurrent dyspnea started three years ago, and hospitalization was required in July 2016 for heart failure. The clinical examination noted a dysmorphic syndrome, obesity, and global heart failure [Figure 1]. The heart rate was 100 beats per minute, and the blood pressure was 180/100 mmHg. A diastolic blowing of aortic regurgitation was perceived with 3/6th of intensity. Chest radiography showed cardiomegaly (cardio-thoracic ratio (CTR) =64%). The electrocardiogram was in sinus rhythm with left atrial and ventricular hypertrophy. Doppler echocardiography showed an ejection fraction at 46%, dilatation of cardiac cavities (left ventricular [LV] =69 mm, right ventricular [RV] =31.8 mm, LA = 37 cm2, and RA = 40 cm2), and concentric LV hypertrophy (septal and parietal thickness at 17.5 mm). The diameter of the aorta was 41 mm, aortic valve seemed normal with anyway a severe regurgitation (Pressure half time [PHT]= 173 ms, regurgitant volume at 69 ml/beat), [Figure 2]. Pulmonary artery systolic pressure was 61 mmHg. Magnetic resonance imaging showed a large pituitary adenoma with suprasellar development, measuring 3 cm × 2.1 cm with a large symmetrical enlargement of the floor of sella turcica [Figure 3]. Biology showed a high level of growth hormone (hGH >150 mIU/l). Thyroid-stimulating hormone, prolactinemia, cortisolemia, and fasting glucose were normal.{Figure 1}{Figure 2}{Figure 3}

Global heart failure and severe aortic regurgitation were retained in a 50-year-old male with a pituitary adenoma responsible of acromegalic dysmorphia.

Daily medical treatment included perindopril 10 mg, furosemide 40 mg, and amlodipine 10 mg. Because pituitary adenoma and dysmorphic syndrome remained stable, cardiac surgery for aortic valve replacement was indicated.

 Discussion



Acromegaly is a rare condition.[1],[3] Cardiovascular manifestations which are present in one-third of cases are related to the age at the diagnosis and the duration of the evolution of the disease.[2] It can cause high blood pressure, physical limitation, or heart failure. Rhythm disorders have also been reported.[1],[2] Their mechanisms are crossed: hypertension, hypertrophy, and dilation of the left ventricle.[2],[4] The presence of valvulopathy is poorly reported.[1],[3],[4] However, in Desailloud et al.'s study conducted in France,[2] the relative risk of occurrence of valvulopathy in an acromegalic disease was 19%. Hence, in their study of 40 cases of acromegaly, aortic regurgitation had appeared in 30% of patients.

 Conclusion



Cardiac manifestations are possible during acromegaly. The association of valvulopathy is rare, and its mechanism is unclear.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Rados L, Jenni S, Christ E. Acromégalie: Diagnosis and management in 2016. Forum Med Suisse 2016;16:605-12.
2Desailloud R, Crépin-Hemon S, Simovic-Corroyer B. Acromegaly in elderly people. Ann Endocrinol (Paris) 2005;66:540-4.
3Monabeka HG, Bouenizabila E, Nsakala-Kibangou N, Mbadinga-Mupangu H, Etitiele F. Acromegalie: About five à propos cases. Med Afr Noire 1999;46:211-4.
4Devoitille A, Beckers A, Piérard LA. Clinical case of the month. Cardiac complications of acromegaly: A rare cause of dilated cardiomyopathy. Rev Med Liege 2012;67:174-8.