J Korean Soc Endocrinol.  2002 Feb;17(1):110-116.

A Case of Acromegaly with Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis

• Lee CY
• Lee MK
• Lee SY
• Hong SN
• Kim HH
• Kang BH
• Kang HW
• Lee BW
• Park YJ
• Min YK
• Lee MS
• Kim KW
• Kim JH

Abstract

Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 mg/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70~110 mg/dL, 13~100 U/L and 13~190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 mg/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 cm sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis

MeSH Terms

Abdominal Pain
Acidosis
Acromegaly*
Adult
Alcohol Drinking
Amylases
Blood Gas Analysis
Blood Glucose
Diabetes Mellitus
Diabetic Ketoacidosis*
Gluconeogenesis
Glucose
Glucose Intolerance
Glycogenolysis
Growth Hormone
Humans
Hypertriglyceridemia
Insulin
Lipase
Magnetic Resonance Imaging
Male
Nausea
Pancreatitis*
Pituitary Neoplasms
Precipitating Factors
Triglycerides
Vomiting
Amylases
Blood Glucose
Glucose
Growth Hormone
Insulin
Lipase