{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:10:03Z","timestamp":1756293003632,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 30-year-old Filipino man presented with a 11-year history of coarse facial features and progressive enlargement of hands and feet. Initial work-up revealed elevated insulin-like growth factor-1 and non-suppressible growth hormone level after 75\u2005g glucose challenge test. Initial cranial MRI performed in the year 2010 showed absence of pituitary adenoma. The patient was lost to follow-up. He again consulted in the year 2011 and a repeat cranial MRI and a dedicated pituitary MRI were performed and both did not reveal any pituitary mass. Further investigation included chest and abdominal CT scan, both of which did not show any neoplasm. At present, there has been no practice guideline on the management of acromegalic patients on whom the identifiable source cannot be found. The patient was given the option to undergo surgical exploration of the pituitary gland or medical treatment with somatostatin analogues. He decided to undergo surgery but has not given consent for the procedure.<\/jats:p>","DOI":"10.1136\/bcr-2012-007604","type":"journal-article","created":{"date-parts":[[2013,1,18]],"date-time":"2013-01-18T01:53:20Z","timestamp":1358474000000},"page":"bcr2012007604","source":"Crossref","is-referenced-by-count":0,"title":["Where is the culprit? A case of acromegaly that defied the management algorithm"],"prefix":"10.1136","volume":"2013","author":[{"given":"Celito A","family":"Tamban","sequence":"first","affiliation":[{"name":"Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark Anthony S","family":"Sandoval","sequence":"additional","affiliation":[{"name":"Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances Lina","family":"Lantion-Ang","sequence":"additional","affiliation":[{"name":"Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,1,17]]},"reference":[{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4158\/EP.10.3.213","article-title":"American association of clinical endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly","volume":"10","author":"Cook","year":"2004","journal-title":"Endocr Pract"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.2","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-3-17"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.3","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1172\/JCI118467","article-title":"Carney complex, a familial multiple neoplasia and lentiginosis syndrome: analysis of 11 kindreds and linkage to the short chromosome 2","volume":"97","author":"Stratakis","year":"1996","journal-title":"J Clin Invest"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.8.2621"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.5","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1330451"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.6","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1055\/s-0029-1212081","article-title":"Acromegaly in a family without mutation in the menin gene","volume":"107","author":"Ackermann","year":"1999","journal-title":"Exp Clin Endocrinol Diabetes"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.7","doi-asserted-by":"publisher","DOI":"10.1126\/science.1126100"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-2513"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.9","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0700004104"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.10","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.2214\/ajr.154.5.2108545","article-title":"The diagnosis of acromegaly: value of inferior petrosal sinus sampling","volume":"154","author":"Doppman","year":"1990","journal-title":"AJR Am J Roentgenol"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.11","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-009-0205-z"},{"key":"2025082703291376000_2013.jan16_1.bcr2012007604.12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0570"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2012-007604","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:29:25Z","timestamp":1756290565000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2012-007604"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1,17]]},"references-count":12,"alternative-id":["10.1136\/bcr-2012-007604"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2012-007604","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2013,1,17]]}}}