Endocrine Abstracts

Introduction: Glucocorticoids are hormones that are used extensively in medicine for their anti-inflammatory and immunomodulatory effects. New onset diabetes mellitus is a frequent complication and is the result of an activation of glucocorticoid receptors which stimulate hepatic gluconeogenesis, adipose tissue lipolysis and increase the insulin resistance.

Case presentation: We present a case of a 49-year-old Ukrainian female who in 2015 started having headaches and a decrease in visual acuity. The dysmorphic features at the clinical exam were suggestive of acromegaly and an invasive 3 cm pituitary adenoma was found. The tumor was partially resected in 2015 in Ukraine, then the patient stopped seeing her endocrinologist until 2020, when an MRI showed an invasive 4 cm pituitary tumor. A somatostatin analogue treatment was introduced with poor medical adherence. The treatment was again interrupted in February 2022 due to drug shortage after the outbreak of Ukraine War. In April 2022 the patient was hospitalized in Romania and an IGF-1 of 837 ug/ml was detected. The MRI showed a minimal tumoral growth compared to 2020. A second neurosurgical intervention was refused because of major risks. A somatostatin analogue treatment was reintroduced along with growth hormone receptor antagonist and a dopamine agonist. Conventional radiotherapy was conducted during which the patient developed intracranial hypertension that required Dexamethasone. Blood sugar was monitored regularly during corticoid treatment and in July 2022 the patient developed diabetes mellitus (glycaemia 600 mg/dl, HbA1c 7.78%) that required basal bolus insulin regimen and Metformin. Dexamethasone was switched for Prednisone then it was gradually reduced and interrupted in august 2022. The insulin was interrupted in October 2022 and the Metformin treatment was continued because of a persistent impaired fasting glycaemia. The MRI at 3 months after radiotherapy shows a tumoral reduction compared to April 2022 (35/28/40 mm vs 35/30/47 in April 2022) and an IGF-1 value of 258 ng/ml, still slightly above the upper limit, so Pegvisomant was increased.

Conclusion: Glucocorticoids are very useful for their anti-inflammatory effect but they are associated with a wide range of side effects including disturbances of the carbohydrate metabolism, due to their stimulation of glucocorticoid receptors with a diabetogenic effect in different organs. New treatments that could retain the anti-inflammatory properties without having the diabetogenic effects are currently being researched. Selective glucocorticoid receptor agonists and 11beta-Hydroxysteroid dehydrogenase type 1 inhibitors are currently being tested in clinical trials but they show limited efficacy.