Diabetic ketoacidosis: an unusual presentation of acromegaly

Abstract

SUMMARYSecondary diabetes mellitus is known to occur in acromegaly due to insulin resistance caused by growth hormone excess. However, diabetes in acromegaly usually does not lead to ketosis. We describe an unusual case of a patient that presented with diabetic ketoacidosis in the emergency room with thirst, polyuria and dyspnoea. The patient was subsequently diagnosed with a growth hormone-secreting pitutary macroadenoma as the underlying pathology; after initial stabilisation with insulin and fluids, the patient was successfully treated with trans-sphenoidal surgery. BACKGROUND

Cases of diabetic ketoacidosis as an initial presentation of acromegaly

“…Diabetic ketoacidosis as an initial presentation of acromegaly documented in our subjects has been reported in the literature [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. However, in many of these reports, DKA occurred in subjects with prior diagnosis of acromegaly [9,[11][12][13][14][15]23].…”

“…In this disorder, serum ACTH and Cortisol levels are not suppressed by administration of a single overnight dose of dexamethasone 1 mg or daily administration of 2 mg (0.5 mg every 6 hours) for 2 days while higher daily dose, 8 mg or 16 mg promptly induces suppression [7]. Finally, the finding of suppression of HGH and IGF1 concentrations by severe hyperglycemia in acromegaly is not documented in the literature [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

“…However, in many of these reports, DKA occurred in subjects with prior diagnosis of acromegaly [9,[11][12][13][14][15]23]. Moreover, in a few these subjects as well as those manifesting DKA as initial presentation, the onset of DKA could be attributed to an acute disorder [8,10,11,[13][14][15]20,23,24]. Finally, long lasting total remission of diabetes not requiring any intervention as noted in our subjects has been rarely documented [11,13,15,19].…”

A rare presentation of diabetic ketoacidosis: meningeal syndrome

“…Current knowledge and available reports suggest that an atypical presentation of DKA is quite unusual. An interesting initial presentation of an acromegaly patient with DKA due to prolonged hyperglycemia was previously reported (5). However, reports of meningeal irritation associated with DKA are extremely rare (6) Several authors have suggested that cerebral edema associated with DKA may cause meningeal irritation in DKA (7-9).…”

Long-Term Follow-up of a Case with Proprotein Convertase 1/3 Deficiency: Transient Diabetes Mellitus with Intervening Diabetic Ketoacidosis During Growth Hormone Therapy

“…However, since the insulin requirement was transient even in the course of rhGH therapy in our patient, it is difficult to consider GH as the sole factor responsible for deterioration of glucose metabolism. Diabetic ketoacidosis can complicate cases with excess GH secretion such as gigantism or acromegaly ( 13 , 14 , 15 ). However, we found only one report of a patient developing diabetic ketoacidosis during GH therapy ( 16 ).…”