Type 1 Diabetes Associated with Asymptomatic Acromegaly Successfully Treated with Surgery after Pregnancy: A Case Report

Abstract

Abstract. We report a rare case of type 1 diabetes in a woman associated with acromegaly who was treated with surgery after pregnancy. An 18-year-old woman came to our hospital in April, 1998, complaining of thirst, polydipsia, polyuria, appetite loss, body weight loss of 8 kg in a month, and amenorrhea beginning 2 months earlier. Based on laboratory data, she was diagnosed as having type 1 diabetes mellitus. Although we suspected her of having acromegaly because of high growth hormone (GH) levels (6.9 or 8.5 ng/ml), blood levels of insulin-like growth factor 1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were within normal range and the circadian rhythm of her blood GH levels was normally maintained. Her blood GH level was elevated to 12.6 ng/ml 15 minutes after a TRH administration. Blood GH levels were suppressed from 49 ng/ml to 1.5 ng/ml 4 hours after an oral administration of 2.5 mg of bromocriptine. A magnetic resonance images (MRIs) showed pituitary swelling, but no nodules were found in the pituitary. Therefore, we diagnosed her as having acromegaly and observed her without surgery, while prescribing diet therapy and intensive insulin therapy for diabetes. We started a treatment of oral administration of 7.5 mg of bromocriptine per day for the acromegaly from April 28, 2000, because her elevated GH was suspected of causing her diabetes to be poorly controlled. During a pregnancy from October, 2000 to September, 2001, diabetic control was improved with increased administration of insulin under a constant dose of bromocriptine. She delivered a normal full-term infant. After the bromocriptine therapy was stopped as she hoped to breastfeed, blood levels of GH and IGF-1 became elevated and her diabetic control deteriorated. As her pituitary tumor observed in pituitary MRIs became larger during the course, a transsphenoidal surgery was performed on March 8, 2002. After the surgery, blood levels of GH and IGF-1 lowered and diabetic control improved again. We concluded as follows: to rule out acromegaly in patients with poorly controlled diabetes, 1) measurements of serum GH and IGF-1 should be performed, and 2) pituitary MRIs should be performed if blood levels of GH or IGF-1 are high.

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

“…Occasional patients, however, may show worsening of disease activity (mostly persistent headache) and/ or visual impairment that will require medical therapy to be reconsidered and, more rarely, even surgical intervention. Although the overall risks of metabolic and/or visual deterioration are usually acceptable, they are highest among patients with poor pre-pregnancy control of disease (3), with acromegaly diagnosed during pregnancy (59,68), and in those with pituitary adenomas closer to the optic chiasm (45). Tumor expansion, usually asymptomatic, has been observed after interruption of treatment in patients with recent shrinkage of the tumor with somatostatin analogs (2,50).…”

Effects of octreotide exposure during pregnancy in acromegaly

“…[1][2][3][4][11][12][13][14][15][16][17][18][19] The outcomes of the SSA exposition was compared to a time-matched (1989 to date) group of acromegalic women not exposed to SSAs. [2][3][4][20][21][22][23][24][25][26][27][28][29]…”