Abstract
Carbohyrate intolerance is a common feature of acromegaly. Frank diabetes mellitus is seen in about 10–20% of patients. There is no report of acromegaly presenting with diabetic ketoacidosis (DKA), associated with retinitis pigmentosa (RP), in the literature. We report the occurrence of DKA and RP in a patient with acromegaly. A 39-year-old Turkish man was admitted to the emergency ward with a 1-mo history of thirst, polyuria, weight loss of 10 kg, and loss of consciousness for 2 d. Physical examination revealed findings suggestive of acromegaly, including coarse facial features and enlargement of his hands and feet. At ophthalmological examination, funduscopy showed RP. Laboratory studies confirmed the diagnoses of DKA and acromegaly. Magnetic resonance imaging disclosed the presence of a pituitary adenoma. During the medical treatment with octreotide, symptomatic sinusoidal bradycardia was developed (pulse rate 45 bpm, and blood pressure 70/40 mmHg). Octreotide therapy was stopped. Pituitary adenoma was removed surgically. For treatment of DKA, insulin need was very high in the first days after the onset of ketoacidosis, but decreased after initiation of treatment with octreotide and after successful operation. Insulin was stopped 7 d after surgery. Follow-up showed normalization of growth hormone levels and plasma glucose levels. Only six other cases of DKA associated with acromegaly and only three other cases of RP associated with acromegaly were found in the medical literature. In conclusion, to our knowledge, the present case is a first report of DKA and RP in patient with acromegaly.
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References
American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice For The Diagnosis and Treatment of Acromegaly. AACE Acromegaly Guidelines Task Force. (2004) Endocr. Pract. 10, 213–225.
Kopff, B., Mucha, S., Wolffenbuttel, B. H. R., and Drzewoski, J. (2001). Med. Sci. Monit. 7, 142–147.
Colao, A., Ferone, D., Marzullo, P., and Lombardi, G. (2004). Endocr. Rev. 25, 102–152.
Kreze, A., Kreze-Spirova, E., and Mikulecky, M. (2001). Braz. J. Med. Biol. Res. 34, 1429–1433.
Vidal Cordata, J., Conget Donlo, J. I., Navarro Tellez, M. P., Halperin Rabinovic, I., and Vilardell Latorre, E. (1995) Ann. Med. Interna. 12, 76–78.
Abramson, M. J. (1990). Lancet 336, 318–319.
Szeto, C. C., Li, K. Y., Chow, C. C., Yeung, V. T., Chan, J. C., and Cockram, C. S. (1997). Int. J. Clin. Pract. 51, 476–477.
Katz, J. R., Edwards, R., Khan, M., and Conway, G. S. (1996). Posigrad. Med. J. 72, 682–683.
Westphal, S. A. (2000). Endocr. Pract. 6, 450–452.
Cosemans, I., Demaerel, P., Wets, B., De Hauwere, B., and Spileers, W. (1999). Doc. Ophthalmol. 98, 175–181.
Smail, J. M. (1972). Br. J. Ophthalmol. 56, 25–31.
Nabarro, J. D. (1987). Clin. Endocrinol. 26, 481–512.
Schade, D. S. and Eaton, R. P. (1979). Diabetes Care 2, 296–306.
Marshall, S. M., Walker, M., and Alberti, K. G. M. (1992). In: International textbook of diabetes mellitus Alberti, K. G. M. M. (ed.) John Wiley: Chichester, pp. 1151–1164.
Hirose, T., Kuroda, T., Otsuki, M., et al. (1997). Intern. Med. 36, 345–350.
Colao, A., Ferone, D., Cappabianca, P., et al. (1997). J. Clin. Endocrinol. Metab. 82, 3308–3314.
Sato, K., Takamatsu, K., and Hashimoto, K. (1995). Endocr. J. 42, 739–745.
Sandoz Pharmaceuticals. (1996). Sandostatin product information. East Hanover, NJ.
Dilger, J. A., Rho, E. H., Que, F. G., and Sprung, J. (2004). Anesth. Analg. 98, 318–320.
Herrington, A. M., George, K. W., and Moulds, C. C. (1998). Pharmacotherapy 18, 413–416.
Erbas, T., Usman, A., Erbas, B., Varoglu, E., Aras, T., and Bekdik, C. (1993). J. Endocrinol. Invest. 16, 857–861.
Sabat, M., Guarner, C., Soriano, G., et al. (1998). Dig. Dig. Sci. 43, 2184–2189.
Gaudin, C., Moreau, R., Champigneulle, B., Soubrane, O., Kleber, G., and Lebrec, D. (1995). Liver 15, 236–241.
Day, S. M., Gu, J., Polak, J. M., and Bloom, S. R. (1985) Br. Heart J. 53, 153–157.
McCormick, P. A., Chin, J., Greenslade, L., et al. (1995). Hepatology 21, 1255–1260.
Katz, M. D., and Erstad, B. L. (1989). Clin. Pharm. 8, 255–273.
Henning, R. J., and Sawmiller, D. R. (2001) Cardiovasc. Res. 49, 27–37.
Baumann, G. (2001). In: Principles and practice of endocrinology and metabolism. 3rd ed. Becker, K. L. (ed.) Lippincott Williams and Wilkins. Philadelphia, PA, pp. 129–145.
Scanelli, G., Dattola, L., and Padovani, F. (1996) J. Endocrinol. Invest. 19, 647–648.
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Erem, C., Ersöz, H.Ö., Ukinç, K. et al. Acromegaly presenting with diabetic ketoacidosis, associated with retinitis pigmentosa and octreotide-induced bradycardia. Endocr 30, 145–149 (2006). https://doi.org/10.1385/ENDO:30:1:145
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DOI: https://doi.org/10.1385/ENDO:30:1:145