Growth hormone (GH)–secreting pituitary adenomas are rare, accounting for less than 12% of pituitary tumors. Chronic GH and insulin-like growth factor-1 (IGF-1) excess in adults results in acromegaly, a condition usually diagnosed late due to its slow and subtle clinical progression. Untreated disease leads to significant cardiovascular, metabolic, gastrointestinal, and neurologic complications. This case report aims to describe the clinical course, surgical management, biochemical response, and early recurrence of a pituitary macroadenoma presenting as acromegaly in a young adult male.

A detailed review of the patient's clinical presentation, endocrine evaluation, imaging studies, operative findings, histopathology, and postoperative course was performed. Relevant hormonal assays, including IGF-1 and pituitary hormone levels, were analyzed. Imaging included serial cranial MRI with pituitary protocol before and after transsphenoidal surgery. Follow-up consultations and management decisions were documented, with emphasis on recurrence and treatment options when radiotherapy was deemed unsuitable.

A 35-year-old man presented with a decade-long history of headaches and progressive acral enlargement, coarse facial features, prognathism, and visual disturbances. MRI revealed a 1.9 × 2.4 × 3.0 cm pituitary macroadenoma with suprasellar extension. Hormonal evaluation demonstrated markedly elevated IGF-1 and fasting insulin, with low testosterone levels. The patient underwent endoscopic intranasal transsphenoidal hypophysectomy, and histopathology confirmed pituitary adenoma. Postoperatively, the patient experienced symptomatic improvement, although transient rhinorrhea required lumbar drainage. Despite surgery, IGF-1 levels remained persistently elevated, and repeat MRI at 12 weeks revealed early tumor recurrence with renewed peripheral visual blurring. Gamma knife radiosurgery was contraindicated due to optic nerve involvement. The patient was subsequently initiated on octreotide, a somatostatin analogue, for biochemical control and tumor stabilization.

This case highlights the challenges in managing GH-secreting pituitary macroadenomas, particularly those with suprasellar extension and early postoperative recurrence. While transsphenoidal surgery remains first-line therapy, biochemical persistence and rapid regrowth may occur, necessitating timely initiation of medical therapy. Early recognition of acromegaly, comprehensive endocrine evaluation, and multidisciplinary management are essential to reducing irreversible complications and improving long-term outcomes. Increased awareness of acromegaly in clinical practice is vital, especially in settings where diagnosis is often delayed.