title: Acromegaly associated with type 2 diabetes showing normal IGF-1 levels under poorly controlled glycemia.
abstract: Acromegaly is caused by excessive secretion of growth hormone (GH), and a resultant persistent elevation of insulin-like growth factor-1 (IGF-1) levels. Diabetes mellitus is accompanied in some acromegalic patients with insulin resistance. We encountered a type-2 diabetic patient who had a poorly controlled glycemic state and was diagnosed as acromegaly with normal IGF-1 levels. The patient showed definite acromegalic features. However, in the first screening test, GH levels were high and IGF-1 levels were inappropriately normal so the results were not close to the diagnosis of acromegaly. After moderate glycemic control, an oral glucose suppression test was performed, showing no suppressed GH response. TRH test revealed paradoxical increases in growth hormone levels and a brain MRI discovered a pituitary adenoma. After several-months insulin treatment, IGF-1 levels were increased to the abnormal state and GH levels were decreased without treatment for acromegaly. Here we report the rare case of acromegaly that presents inappropriately normal IGF-1 levels at the time of diagnosis in uncontrolled type 2 diabetic patient and shows increased IGF-1 levels after glycemic control with insulin therapy. When evaluating acromegaly in type 2 diabetes under poorly controlled glycemia, cautious IGF-1 analysis is needed after sufficient glycemic control.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, Korea.
authors.forename: Dong Jun
authors.initials: DJ
authors.lastname: Lim
authors.forename: Hyuk Sang
authors.initials: HS
authors.lastname: Kwon
authors.forename: Jae Hyoung
authors.initials: JH
authors.lastname: Cho
authors.forename: Sang Hee
authors.initials: SH
authors.lastname: Kim
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Choi
authors.forename: Kun Ho
authors.initials: KH
authors.lastname: Yoon
authors.forename: Bong Yun
authors.initials: BY
authors.lastname: Cha
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Lee
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Son
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Kang
mesh_terms: D000172:Acromegaly / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism*; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I