{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T13:38:03Z","timestamp":1771508283378,"version":"3.50.1"},"reference-count":9,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,26]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>This case describes a presentation of a patient with clinical features of acromegaly, elevated growth hormone (GH) concentrations, a pituitary adenoma but with normal insulin-like growth factor-1 (IGF-1) concentrations in the context of previously undiagnosed liver cirrhosis. In this case, a diagnosis of acromegaly was made based on clinical grounds and failure of GH to suppress during oral glucose tolerance testing despite a normal IGF-1 screening test. Following liver transplantation, the patient\u2019s IGF-1 concentrations rose significantly in keeping with a diagnosis of active acromegaly. This case demonstrates the importance of history, physical examination and clinical judgement in the diagnosis of this rare disease. It also highlights the vital role played by the liver in the GH\/IGF-1 axis.<\/jats:p>","DOI":"10.1136\/bcr-2025-266505","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:55:13Z","timestamp":1771505713000},"page":"e266505","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acromegaly presenting with normal insulin-like growth factor-1 levels in a patient with advanced liver cirrhosis"],"prefix":"10.1136","volume":"19","author":[{"given":"Ciara","family":"Kilcoyne","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Beaumont Hospital, Dublin 9, Leinster, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beaumont Hospital, Dublin 9, Leinster, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael W","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beaumont Hospital, Dublin 9, Leinster, Ireland"},{"name":"Department of Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masood","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Liver Unit, St Vincent\u2019s University Hospital, Dublin, Leinster, Ireland"},{"name":"University College Dublin, Dublin, Leinster, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Sherlock","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beaumont Hospital, Dublin 9, Leinster, Ireland"},{"name":"Department of Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"2026021904550670000_19.2.e266505.1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s11102-016-0754-x","article-title":"Epidemiology of acromegaly: review of population studies","volume":"20","author":"Lavrentaki","year":"2017","journal-title":"Pituitary"},{"key":"2026021904550670000_19.2.e266505.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2700"},{"key":"2026021904550670000_19.2.e266505.3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-3059"},{"key":"2026021904550670000_19.2.e266505.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03556.x"},{"key":"2026021904550670000_19.2.e266505.5","doi-asserted-by":"crossref","first-page":"395","DOI":"10.3803\/EnM.2015.30.3.395","article-title":"Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation","volume":"30","author":"Lee","year":"2015","journal-title":"Endocrinol Metab"},{"key":"2026021904550670000_19.2.e266505.6","doi-asserted-by":"crossref","DOI":"10.1186\/s13256-015-0736-z","article-title":"Acromegaly presenting with low insulin-like growth factor-1 levels and diabetes: a case report","volume":"9","author":"Wijayaratne","year":"2015","journal-title":"J Med Case Rep"},{"key":"2026021904550670000_19.2.e266505.7","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1620\/tjem.216.325","article-title":"Acromegaly with normal IGF-1 levels probably due to poorly controlled diabetes mellitus","volume":"216","author":"Arihara","year":"2008","journal-title":"Tohoku J Exp Med"},{"key":"2026021904550670000_19.2.e266505.8","doi-asserted-by":"publisher","DOI":"10.4065\/81.2.238"},{"key":"2026021904550670000_19.2.e266505.9","doi-asserted-by":"crossref","first-page":"R1","DOI":"10.1093\/ejendo\/lvae065","article-title":"IGF-I assay methods and biologic variability: evaluation of acromegaly treatment response","volume":"191","author":"Clemmons","year":"2024","journal-title":"Eur J Endocrinol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266505","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:55:14Z","timestamp":1771505714000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266505"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":9,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,19]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bcr-2025-266505"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266505","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}