Thirty-eight years gentleman presented with DKA as the first presentation of his diabetes. His HbA1c was 12%. On exam, he showed features of Acromegaly and normal BMI. His Growth hormone and IGF-1 were very high in confirming the diagnosis of Acromegaly. His Anti GAD and Anti Islet cell antibodies are negative. MRI dedicated pituitary showed pituitary macroadenoma. Treatment of his DKA was difficult. He was discharged on insulin. Later, the patient was seen in the endocrine clinic. Insulin dose was reduced gradually till completely stopped due to recurrent hypos. He also mentioned marked improvement of his Acromegaly symptoms. GTT showed appropriate Growth hormone response and his maximum blood sugar was 7.5 mol/L. also his IGF-1became normal. After the disappearance of his symptoms and normalization of his blood sugar, Growth hormone and IGF 1, the patient was scheduled for another MRI pituitary which showed cystic changes and marked reduction of his pituitary adenoma size. Further, follow up, revealed persistent remission of his diabetes (his HbA1c is 5.4%) and Acromegaly.
Conclusion and Discussion: 1. It is not uncommon for DKA to be the first presentation of DM. Furthermore, DKA could be the first presentation of Acromegaly as well.
2. Secondary diabetes should be considered in any new onset diabetes especially if with an atypical presentation (our patient MBI was not typical of type 2 and his age and antibodies were not typical of type 1). We recommend general physical examination and act upon the findings.
3. Pituitary adenoma showed spontaneously cystic degeneration which cured his excess growth hormone and subsequently his secondary diabetes.
4. Few reported cases in the literature of DKA after stoppage of Octreotide in Acromegaly.
5. Apart from steroid induced hyperglycemia, there are no guidelines to manage secondary diabetes. There is a need for guidelines for diabetes management in Acromegaly.