Acromegaly With HCV- An Uncommon Association

Introduction: Hepatitis C Virus (HCV) and acromegaly caused due to excessive secretion of growth hormone are rarely associated but present shared risks, especially for hepatocellular carcinoma (HCC) and metabolic diseases like diabetes, as both GH/IGF-1 excess and HCV promote inflammation and liver damage, with acromegaly potentially accelerating liver progression in HCV patients, requiring multidisciplinary care due to overlapping cardiovascular and cancer risks. While HCV can affect liver function (IGF-1 production), acromegaly increases liver stiffness and fibrosis, creating a complex clinical picture. Case report: A seventy-five-year-old male, a chronic alcoholic for last fourty years, taking in significant amount, smoker and not a known case of any chronic illness was being evaluated for pedal edema and ascites. He was confirmed on investigations to be having chronic liver disease. The complete hemogram revealed anemia and thrombocytopenia, with deranged liver function test in form of mild hyperbilirubinemia, transaminitis with reversal of ALT/AST levels, hypoproteinaemia, hypoalbunemia. The ultrasonogram revealed altered echotexture of liver, mild splenomegaly and ascites. The upper gastro-intestinal endoscopy showed grade one esophageal varices. On testing of viral screen, he was found to be having anti HCV antibody test positive with HbsAg and anti -HIV antibody negative & AFP levels, Chest X-ray, ECG were also normal. The HCV RNA quantitative load was 546701 I.U./ml. He was very tall with height of six feet and two inches, large jaw, long hands, fingers and tongue. Hence clinically acromegaly diagnosis was made. The chest, cardiovascular and neurological examination was essentially normal. He was given antiviral treatment with sofosbuvir 400 mg & Velpatasvir 100 mg for total of 24 weeks duration, along with diuretics and other supportive treatment. He was advised to be on high vegetable protein and salt restricted diet. He achieved sustained virological response (SVR) after 12 weeks of completion of treatment., as evidenced by complete absence of HCV RNA on polymerase chain testing (PCR) report. He is on regular follow up for cirrhosis and as a surveillance for Hepatocellular carcinoma (H.C.C) with six monthly ultrasonogram abdomen and alpha feto-protein levels. Conclusion: Our case report highlights the combination of acromegaly with HCV, whether there is any association or incidental finding, is area of further research. There are very few case reports in literature of HCV with acromegaly. Keywords: Acromegaly, Cirrhosis, Chronic Hepatitis C, HCV RNA, Computed tomography Scan