Background/Objective Atypical presentations of acromegaly are rare. We present long-term follow-up of 2 patients with acromegaly who had nonspecific symptoms with elevated growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels but lacked classical clinical features. Case Report The first case was a 34-year-old woman who presented with arthralgias, cognitive slowing, and headaches. An incidental brain magnetic resonance imaging scan showed a cystic pituitary lesion. Laboratory tests performed 2 years after initial presentation showed elevated IGF-1 and GH levels, after which she underwent transsphenoidal surgery and lanreotide treatment for symptom control. The second case was a 78-year-old woman with a history of bipolar disorder in whom brain magnetic resonance imaging revealed a 1.5-cm incidental pituitary macroadenoma. Subsequent screening showed elevated GH and IGF-1 levels. She also had laboratory values consistent with primary hyperparathyroidism. Multiple endocrine neoplasia type-1 was ruled out by history. Following parathyroid surgery, the patient remained eucalcemic. She was started on long-acting octreotide due to reluctance for transsphenoidal surgery. Long-term follow-up of both patients was uneventful. Discussion We recommend the term subclinical acromegaly to refer to such patients. These cases highlight the importance of screening all patients with pituitary lesions using an IGF-1 level regardless of presence of classical symptoms of acromegaly. Conclusion On long-term follow-up, subclinical acromegaly after treatment has a relatively benign course without development of associated comorbidities, although additional studies involving large number of patients are needed.
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