A case of acromegaly diagnosed with diabetic ketoacidosis as a primary manifestation
S. Usui, M. Sue, A. Yoshihara, R. Oka, M. Ishikawa, N. Hiroi, K. Kuboki & G. Yoshino
Although diabetic ketoacidosis (DKA) is recognized one of complications of acromegaly, it is very rare as only five cases are reported as a primary manifestation.
A 43-year-old Japanese woman, who had never pointed out impaired glucose tolerance, had emergency admitted by DKA. Her plasma glucose was 440 mg/dl, HbA1c 15.7%, urinary keton body (3+), BGA pH7.257, then she was cured by rehydration of saline and continues intravenous insulin injection. She was unlikely of type1 nor type2 diabetes because her endogenous insulin secretion was kept, as fasting serum c-peptide was 1.49 ng/ml, urinary c-peptide 85.5 μg/day, GAD antibody negative, and she was not obesity (BMI 20.4 kg/m2).
Because she had acromegalic features, existence of acromegaly was suggested. Her GH and IGF1 levels showed high (155 ng/ml and 476 ng/ml) under hyperglycemia. There were double floor and ballooning in sella turcica Xp, a cauliflower-like change of the distal phalanx in finger Xp. And there are expansion of sella turcica and mass lesion on pituitary MRI (Default 1).
From the above, we had a diagnosis of the acromegaly due to GH-producing pituitary tumor, and DKA had developed from secondary diabetes by it. She finally needed 30 units of insulin a day for diabetes and got good plasma glucose control, and then was transferred for the purpose of receiving pituitary operations.
We experienced a case of acromegaly diagnosed with DKA as a primary manifestation. It is thought that diabetes is complicated with acromegaly as a result of insulin resistance increased by overproducing of the GH, and DKA occurs because of absolute or relative lack of insulin and counter hormones participates in it.
Therefore, like this case, it is necessary to be careful about possibility to be complicated with DKA about acromegaly.
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.