J Korean Soc Endocrinol.  2004 Aug;19(4):393-398.

Diabetic Ketoacidosis in a Patient with Acromegaly

• Koh EH
• Kim MK
• Park JT
• Nam-Goong
• Park JY
• Lee KU
• Kim MS

Abstract

Acromegaly is a chronic, debilitating condition caused by excessive secretion of growth hormone (GH). Impaired glucose tolerance is present in about 20-40% of acromegaly, with diabetes mellitus developing in about 10~15% of patients, but diabetic ketoacidosis is a rare association. Herein is reported a case of diabetic ketoacidosis in a 33 year-old female, with a 4 year history of typical acromegaly features. She presented with severe hyperglycemia and ketoacidosis, but with no other cause for this metabolic derangement. She had elevated plasma GH (50 ng/mL) and IGF-1 (1533 ng/mL) levels, and a pituitary macroadenoma. About 200 units of insulin per day were required for her glycemic control. However, the serum IGF-1 level and daily insulin requirement were significantly tapered after a transsphenoidal adenomectomy and long acting somatostatin analogue treatment. There was a good correlation with the daily insulin requirement and plasma IGF-1 level. This case demonstrates that severe GH excess can cause diabetic ketoacidosis, and that its successful treatment improves glucose metabolism.

MeSH Terms

Acromegaly*
Adult
Diabetes Mellitus
Diabetic Ketoacidosis*
Female
Glucose
Growth Hormone
Humans
Hyperglycemia
Insulin
Insulin Resistance
Insulin-Like Growth Factor I
Ketosis
Metabolism
Plasma
Somatostatin
Glucose
Growth Hormone
Insulin
Insulin-Like Growth Factor I
Somatostatin