Emergency pacemaker implantation in acromegaly

A significant increase of myocardial hypertrophy or dilatation, heart valve disease, and cardiac rythm abnormalities has been described in acromegaly. We report an 82-year-old acromegalic woman with fixed third-degree AV block and wide QRS complex escape rythm which was treated with emergency permanent pacemaker (VVIR) insertion. We discuss how several factors including acromegalic cardiomyopathy, hypothyroidism due to pituitary irradiation, and codeine played a relevant role in disclosing such an advanced AV conduction abnormality. In conclusion, also cured acromegalic patients deserve careful follow-up from both endocrinologists and cardiologists.