Introduction: Acromegaly is an endocrine disorder characterized by hypersecretion of growth hormone (GH), which leads to an overproduction of insulin-like growth factor 1 (IGF-1) generating typical morphological changes such as an increase in the size of the acral parts. Subclinical acromegaly can be considered as a non-functioning adenoma that is immunopositive for GH in surgical piece or as biochemical acromegaly without clinical stigmata.

Case report: We present the case of a 33-year-old female patient with a history of depression and headache under treatment. Her condition began in 2016 when she suffered a seizure event, and the magnetic resonance imaging (MRI) incidentally revealed a pituitary cystic lesion. They completed the study with hormonal evaluation, finding increased levels of IGF-1, and slightly elevated levels of prolactin, the rest of the pituitary axes normal.

Physical examination showed no obvious clinical manifestations of acral growth. Due to the clinical and biochemical behavior, the condition would be compatible with subclinical acromegaly. He was treated with somatostatin analogues, and IGF-1 values normalized; however, due to side effects: alopecia, the treatment was discontinued, with a subsequent increase in IGF-1 levels, so she underwent endoscopic transsphenoidal surgery. The pathology report indicated synaptophysin positive pituitary adenoma. Currently, 2 years after surgery, the patient no longer has the feeling of fatigue and generalized weakness as before, and the IGF-1 levels continue within the normal range.

Conclusion: Cystic pituitary adenomas, although rare, may secrete GH, however, they may present without the classic clinical features of acromegaly. This case emphasizes the importance of a comprehensive clinical, radiological, and complete hormonal assessment, especially in patients presenting with cystic pituitary incidentalomas.

No extra funds were required to carry out the study, and there is no conflict of interest.