Pituitary gigantism presenting with depressive mood disorder and diabetic ketoacidosis in an Asian adolescent
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Sheng-Fong Kuo
Abstract
Hyperglycemia is seldom described in young patients with pituitary gigantism. Here, we describe the case of a 17-year-old Taiwanese boy who developed depressive mood disorder and diabetic ketoacidosis (DKA) at the presentation of pituitary gigantism. The boy complained of lethargy and dysphoric mood in June 2008. He presented at the emergency department with epigastralgia and dyspnea in January 2009. Results of laboratory tests suggested type 1 diabetes mellitus with DKA. However, serum C-peptide level was normal on follow-up. Although he had no obvious features of acral enlargement, a high level of insulin-like growth factor 1 was detected, and a 75 g oral glucose suppression test showed no suppression of serum growth hormone levels. A pituitary macroadenoma was found on subsequent magnetic resonance imaging. The pituitary adenoma was surgically removed, followed by gamma-knife radiosurgery, and Sandostatin long-acting release treatment. He was then administered metformin, 500 mg twice daily, and to date, his serum glycohemoglobin has been <7%.
References
1. Eugster EA, Pescovitz OH. Gigantism. J Clin Endocrinol Metab 1999;84:4379–84.10.1210/jcem.84.12.6222Suche in Google Scholar
2. Flitsch J, Spitzner S, Ludecke DK. Emotional disorders in patients with different types of pituitary adenomas and factors affecting the diagnostic process. Exp Clin Endocrinol Diabetes 2000;108:480–5.10.1055/s-2000-8144Suche in Google Scholar
3. Leon-Carrion J, Martin-Rodriguez JF, Madrazo-Atutxa A, Soto-Moreno A, Venegas-Moreno E, et al. Evidence of cognitive and neurophysiological impairment in patients with untreated naive acromegaly. J Clin Endocrinol Metab 2010;95:4367–79.10.1210/jc.2010-0394Suche in Google Scholar
4. Clemmons DR. Roles of insulin-like growth factor-I and growth hormone in mediating insulin resistance in acromegaly. Pituitary 2002;5:181–3.10.1023/A:1023321421760Suche in Google Scholar
5. Anagnostis P, Efstathiadou ZA, Polyzos SA, Adamidou F, Slavakis A, et al. Acromegaly: presentation, morbidity and treatment outcomes at a single centre. Int J Clin Pract 2011;65:896–902.10.1111/j.1742-1241.2011.02682.xSuche in Google Scholar
6. Fieffe S, Morange I, Petrossians P, Chanson P, Rohmer V, et al. Diabetes in acromegaly, prevalence, risk factors, and evolution: data from the French Acromegaly Registry. European J Endocrinol 2011;164:877–84.10.1530/EJE-10-1050Suche in Google Scholar
7. Chen YL, Wei CP, Lee CC, Chang TC. Diabetic ketoacidosis in a patient with acromegaly. J Formos Med Assoc 2007;106:788–91.10.1016/S0929-6646(08)60042-XSuche in Google Scholar
8. Westphal SA. Concurrent diagnosis of acromegaly and diabetic ketoacidosis. Endocr Pract 2000;6:450–2.Suche in Google Scholar
9. Bhansali A, Upreti V, Dutta P, Mukherjee KK, Nahar U, et al. Adolescent acromegaly: clinical parameters and treatment outcome. J Pediatr Endocrinol Metab 2010;23:1047–54.10.1515/jpem.2010.166Suche in Google Scholar PubMed
10. Kuzuya T, Matsuda A, Sakamoto Y, Yamamoto K, Saito T, et al. A case of pituitary gigantism who had two episodes of diabetic ketoacidosis followed by complete recovery of diabetes. Endocrinol Jpn 1983;30:329–34.10.1507/endocrj1954.30.329Suche in Google Scholar PubMed
11. Alvi NS, Kirk JM. Pituitary gigantism causing diabetic ketoacidosis. J Pediatr Endocrinol Metab 1999;12:907–9.Suche in Google Scholar
12. Ali O, Banerjee S, Kelly DF, Lee PD. Management of type 2 diabetes mellitus associated with pituitary gigantism. Pituitary 2007;10:359–64.10.1007/s11102-007-0060-8Suche in Google Scholar PubMed
©2013 by Walter de Gruyter Berlin Boston
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