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208 Pituitary magnetic resonance imaging re‐ vealed an enlarged gland (24 × 13 × 12 mm), with extrasellar extension, and homogenous Acromegaly due to ectopic growth hormone–re‐ leasing hormone (GHRH) secretion from a neu‐ roendocrine tumor (NET) is very rare, and up to 100 cases have been reported in the litera‐ ture.1 Pancreatic or bronchial NETs are the pri‐ mary sources of GHRH, but pheochromocyto‐ mas were also described.2-5 To the best of our knowledge, we report the first case of acromeg‐ aly due to GHRH ‐producing NET causing pitu‐ itary hyperplasia and resulting in partial pitu‐ itary insufficiency. A 43 ‐year ‐old woman was referred to our de‐ partment with symptoms suggesting acromega‐ ly for about 5 years and amenorrhea for 2 years. The patient presented with typical acromegaly symptoms: coarsened facial features, macroglos‐ sia, enlarged hands and feet, soft tissue swell‐ ing, marked interdental spacing, and excessive sweating (FIGURE 1A). Her medical history was no‐ table for bilateral surgery for carpal tunnel syn‐ drome. Hormonal evaluation revealed normal thyroid function, normal prolactin levels, hypo‐ gonadotropic hypogonadism (luteinizing hor‐ mone [LH], 1.3 U/l; follicle ‐stimulating hormone [FSH] 6.3 U/l, and estradiol <10 pg/ml), second‐ ary hypocortisolism (adrenocorticotropic hor‐ mone [ACTH] 08:00 AM, 6.2 pg/ml; cortisol 8:00 AM, 3.5 μg/dl), elevated fasting growth hormone (GH) levels (44 μg/l), and insulin ‐like growth fac‐ tor 1 (IGF ‐1) levels exceeding 3.3 ‐fold the upper limit of normal (ULN). Nonsuppressed GH levels during the 75 ‐g oral glucose tolerance test were noted (nadir, 17 μg/l). CLINICAL IMAGE

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Ectopic acromegaly due to growth hormone-releasing hormone producing bronchial carcinoid causing somatotroph hyperplasia and partial pituitary insufficiency