Pericardial effusion and non-constrictive diastolic dysfunction in acromegaly

Acromegaly due to growth hormone excess is a rare condition with a prevalence of 60 per million and an incidence of 3–4 per million and year. Increase of morbidity and mortality is predominantly associated with cardiovascular disease. We report on a 73-year-old female patient with a large pericardial effusion. Measurement of growth hormones confirmed the suspected active hyperpituitarism: growth hormone was 11.8 ng/ml, insulin-like growth factor-1 was 1401 μg/l (normal 5–199 μg/l). The patient underwent cardiac magnetic resonance (CMR) imaging to asses systolic and diastolic cardiac function as well as left ventricular (LV) muscle mass. In contrast to initially suspected cardiac hypertrophy, LV mass was 107 g (58 g/m2) and, thus, not increased (75–175 g, normalized 63–95 g/m2). Of note, LV volumes were reduced markedly to 60 ml (33 ml/m2) at enddiastole and 12 ml (7 ml/m2) at endsystole; accordingly, the LV ejection fraction was 80%. Subsequently, pericardiocentesis was performed. Noteworthy, diastolic filling was not improved subsequently as assessed by follow-up CMR examination.To our best knowledge, occurrence of pericardial effusion has not yet been described in patients with acromegaly. In contrast to an excellent systolic LV function, diastolic impairment was shown. Of note, diastolic dysfunction remained despite pericardiocentesis. Since also constrictive pericarditis did not occur, myocardial disturbances bearing functional resemblance to restrictive filling pattern have to be considered. Since the accuracy of CMR is favourable when compared with other methods, its diagnostic routine use should be taken into account to assess morphology and function of cardiomyopathy in patients with acromegaly.