Endocrine Abstracts

Plurihormonal pituitary adenomas represent 10-15% of all functioning pituitary adenomas. Functioning ACTH-GH pituitary adenomas constitute an extremely rare entity. Most patients present a clinically manifested acromegaly and subclinical Cushing’s disease. We present the case of a 14 years old female who referred to the endocrinology department for inaugural diabetic ketosis. She had a six-month history of amenorrhea and headaches. On examination, she had facial dysmporphia suggestive of acromegaly. Weight was 93 kg, height was 1.77 m. The body mass index was 29,3 kg/m². Blood pressure was normal; she had purple abdominal stretch marks. Polysomnography revealed a mild sleep apnea. The hormonal assessment confirmed acromegaly by a nadir of GH of 39 mUI/l in glucose tolerance test. A none suppressive cortisol secretion of 8.9 mg/dl and a high ACTH of 29.14 ng/l. Thyrotropic and lactotropic axis were normal, The gonadotropic axis was deficient. MRI showed a macroadenoma of 18*14*20 mm that extends into the cavernous sinus and compresses the optic chiasm. The patient received basal-bolus insulin therapy. She underwent transsphenoidal surgery. Postoperatively presented with clinical and biochemical adrenal insufficiency and had a transient insipidus diabetes. The MRI documented an empty sella. At a one-year follow-up she was clinically well with no clinical or radiological evidence of pituitary tumor recurrence. She remained on replacement hydrocortisone and necessitated low doses of insulin for her diabetes. ACTH-GH plurihormonal pituitary adenomas are a rare entity. This is a case that illustrates an ACTH-GH pituitary adenoma revealed by diabetic ketosis in an adolescent.