Acromegaly is an endocrine disease caused by enhanced growth hormone (GH) production/secretion from the pituitary gland. The most frequently observed underlying disease is GH-producing adenomas in the anterior pituitary. We report the treatment course and change of nasal morphology with time in a patient with mandibular prognathism associated with acromegaly.
A 21-year-old female visited our department with the chief complaint of mandibular protrusion. She showed hypertrophy of the four limbs, thickness of the facial skin, hypertrophy of the nasal alae and lips, protrusion of the upper orbital margin, and cross bite. The GH and somatomedin levels were high. Magnetic resonance imaging (MRI) revealed a tumor in the anterior pituitary. A diagnosis of skeletal mandibular prognathism associated with acromegaly due to a pituitary tumor was made, and the pituitary tumor was resected at the Department of Neurological Surgery of our hospital. Subsequently, since the GH and somatomedin levels decreased almost to the normal ranges, preoperative orthodontic treatment was initiated, and bilateral sagittal splitting ramus osteotomy was performed 18 months after the tumor resection. Stable occlusion was maintained without changes in general condition 24 months after the orthognathic surgery at the age of 26 years 1 month. The nasal morphology markedly changed with time after resection of the pituitary tumor.