Case series of diabetic ketoacidosis as the first presentation of 860 patients with acromegaly
N. Yoshida, H. Suzuki, K. Nagasawa, M. Okubo, A. Takeshita, M. Miyakawa, Y. Mori, T. Fukui, N. Fukuhara, H. Nishioka, S. Yamada & Y. Takeuchi
Background and aims: Excess GH causes insulin resistance resulting in impaired glucose metabolism. Although diabetes mellitus (DM) is common in patients with acromegaly, diabetic ketoacidosis (DKA) is rarely associated with acromegaly. Actually only 11 DKA patients have been anecdotally reported as the first presentation of acromegaly so far. Here we present nine cases of DKA as the first presentation of 860 consecutive patients with acromegaly and their clinical characteristics.
Materials: Data of 860 consecutive acromegaly patients with pituitary surgery in our hospital from 1980 to 2011 were collected.
Results: Nine cases were found to be complicated with DKA before diagnosis of acromegaly, seven males and two females. None of them had been diagnosed as DM. Their average age was 38.8±14.2-year-old, HbA1c 12.1±1.8%, plasma glucose 41.4±21.0 mmol/l, arterial blood pH 7.27±0.09 (means±S.D.). All patients were negative for antibodies related to type 1 DM. The precipitating factor of DKA in six cases was an excessive ingestion of sugar-containing soft drink. After pituitary surgery, plasma glucose levels were in good control without insulin in all cases; furthermore six patients needed no oral hypoglycemic agents. Their insulin secretion capacities were well preserved estimated with 75 g oral glucose tolerance test after surgery.
Conclusion: As we reported, acromegaly enhanced insulin resistance but some acromegalic patients could not compensate insulin secretion accordingly (Eur J Endocrinol 164 467, 2011). Thus, an excessive ingestion of soft drink might predispose them to metabolic failure due to further glucose toxicity. Increased lipolysis by GH could also be involved in the development of DKA. In conclusion, patients with acromegaly may be prone to severe metabolic failure, such as DKA that is the first presentation in 1% of acromegaly. Acromegaly should be added to the list in background diseases of DKA.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.