Akromegalinin Nadir Bir Prezentasyonu: Diyabetik Ketoasidoz

Akromegalide glukoz metabolizması anormallikleri sık görüldüğü halde, diyabetik ketoasidoz nadir bir komplikasyon olarak tanımlanmıştır. Bu makalede 42 yaşında diyabetik ketoasidozlu bir olgu sunulmaktadır. Metabolik bozukluk için bir sebep bulunamayan, insülin ihtiyacı çok yüksek olan olguda laboratuvar çalışmaları ile akromegali saptandı. Hipofiz adenomuna yönelik cerrahi sonrası insülin ihtiyacı belirgin olarak azaldı. Olgumuz nadir bir durum olan diyabetik ketoasidoz ile akromegali birlikteliğini göstermektedir. Akromegali yüksek doz insülin ihtiyacının ayırıcı tanısında göz önünde bulundurulmalıdır.   

An Unusual Presentation Of Acromegaly: Diabetic Ketoacidosis

Although the abnormalities of glucose metabolism were common in acromegaly, diabetic ketoacidosis was described as a rare complication. A case of 42-year-old woman who had diabetic ketoacidosis in this case report. Laboratory studies were confirmed the diagnosis of acromegaly in patient which had no specific cause for metabolic derangement and insulin need was very high. After the pituitary adenoma removed surgically, insulin need was markedly reduced. This case shows the rare association between diabetic ketoacidosis and acromegaly. Acromegaly should be considered in the differential diagnosis of high dose insulin needed.

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  • Chanson P, Salenave S, Kamenicky P, Cazabat L, Young J. Pituitary tumours: acromegaly. Best Pract Res Clin Endocrinol Metab 2009; 23: 555-74.
  • Yoshida N, Goto H, Suzuki H, et al. Ketoacidosis as the initial clinical condition in nine patients with acromegaly: a review of 860 cases at a single institute. Eur J Endocrinol 2013; 169: 127-32.
  • Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 2004; 25: 102-52.
  • Chen YL, Wei CP, Lee CC, Chang TC. Diabetic ketoacidosis in a patient with acromegaly. J Formos Med Assoc 2007; 106: 788-91.
  • Dosi RV, Patell RD, Shah PJ, Joshi HK. Diabetic ketoacidosis: an unusual presentation of acromegaly. BMJ Case Rep 2013; doi:10.1136/bcr-2013-010198.
  • Jiang HJ, Hung WW, Hsiao PJ. A case of acromegaly complicated with diabetic ketoacidosis, pituitary apoplexy, and lymphoma. Kaohsiung J Med Sci 2013; 29: 687-90.
  • Vijayakumar A, Novosyadlyy R, Wu Y, Yakar S, LeRoith D. Biological effects of growth hormone on carbohydrate and lipid metabolism. Growth Horm IGF Res 2010; 20: 1-7.
  • Palakawong P, Arakaki R. Diabetic Ketoacidosis in Acromegaly: A Case Report. Endocr Pract 2012: 1-15.
  • Kinoshita Y, Fujii H, Takeshita A, et al. Impaired glucose metabolism in Japanese patients with acromegaly is restored after successful pituitary surgery if pancreatic {beta}-cell function is preserved. Eur J Endocrinol 2011; 164: 467-73.