acromegaly is a syndrome seen in adults due to excessive production of pituitary growth hormone as a result of an adenoma or hyperplasia of the eosinophilic cells of the anterior pituitary gland .
the main clinical features of acromegaly are skeletal overgrowth affecting the hands , feet , and skull along with spinal deformities like kyphosis .
the interface between psychiatry and endocrinology is well documented and psychiatric problems in various endocrine disorders are well known .
psychiatric issues in acromegaly have been addressed sparsely and no systematic studies exist for the same , though anecdotal case reports are present in literature .
one case depicts pure depression with acromegaly , while another reports the presence of depression with pathological gambling .
other psychiatric symptoms like schneiderian first - rank psychotic symptoms , persecutory delusions , visual and auditory hallucinations , apathy with lack of motivation and mood swings have all been documented in acromegaly .
in all the cases , response to various medications used has been excellent bringing about a reduction of symptoms .
one study on 12 patients with acromegaly failed to prove a relationship between psychopathology and growth hormone levels , while it did mention a sexual dichotomy with 11 patients being female .
a 33-year - old lady from middle socioeconomic class presented with depressed mood , loss of appetite , lack of sleep at night , inability to concentrate on her day - to - day activities , and occasional passive suicidal themes in her thoughts .
the patient had a similar episode three years ago and had responded well to sertraline .
the patient 's father had a history of depression with psychotic features and during his hallucinatory episodes had committed suicide by jumping into a well .
the facial features noted by us were prognathia of the mandible , enlargement of the supro - orbital ridges , enlarged facies , and macroglossia .
on testing after endocrine consultation , the patient had a high fasting blood sugar of 185 mg% while post lunch blood sugar was 210mg% .
the level of growth hormone was 7.2 ng / ml ( normal 0.044.5 ng / ml ) .
a ct scan revealed an enlarged sella tursica and a thickened skull with pituitary enlargement .
the patient was started on escitalopram 10 mg / day with zolpidem 10 mg at night for depressive symptoms .
the patient was also called weekly for cognitive therapy sessions where suicidal and negative thoughts would be addressed .
the patient started responding showing a 20% improvement in the first week itself with 80% symptom reduction at the end of four weeks .
the patient was to undergo treatment with the endocrinologist for acromegaly but was noncompliant and did not follow - up after the fifth week . during the five weeks of clinical observation , improvement was 80% with no worsening of acromegaly symptoms .
it was difficult to label the depression secondary to her acromegaly as the endocrine features did not bother the patient and were detected by us .
a strong family history of depression with psychotic features and suicide of her father may have contributed to her depression .
our limited knowledge and lack of data on the relationship between depression and acromegaly makes it very difficult to comment on any associations .
 depression is one of the commonest disorders encountered in general hospital psychiatry . 
 acromegaly is a condition with excessive growth hormone secretion that may at times present with oversychopathology . 
 we present the case of a 33-year - old lady with depression and acromegaly that successfully resolved after treatment with escitalopram and cognitive therapy . 
INTRODUCTION
CASE REPORT
DISCUSSION