title: Management of type 2 diabetes mellitus associated with pituitary gigantism.
abstract: Pituitary gigantism, a condition of endogenous growth hormone (GH) hypersecretion prior to epiphyseal closure, is a rare condition. In the adult condition of GH excess, acromegaly, the occurrence of type 2 diabetes mellitus (T2DM) and diabetic ketoacidosis (DKA) have been reported, with resolution following normalization of GH levels. We report the case of a 16-year-old male with pituitary gigantism due to a large invasive suprasellar adenoma who presented with T2DM and DKA. Despite surgical de-bulking, radiotherapy and medical treatment with cabergoline and pegvisomant, GH and insulin-like growth factor-I (IGF-I) levels remained elevated. However, the T2DM and recurrent DKA were successfully managed with metformin and low-dose glargine insulin, respectively. We review the pathophysiology of T2DM and DKA in growth hormone excess and available treatment options.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. oali@mcw.edu
authors.forename: Omar
authors.initials: O
authors.lastname: Ali
authors.forename: Swati
authors.initials: S
authors.lastname: Banerjee
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kelly
authors.forename: Phillip D K
authors.initials: PD
authors.lastname: Lee
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery / Q000628:therapy; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077465:Cabergoline; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D004873:Ergolines / Q000627:therapeutic use; D005877:Gigantism / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D019382:Human Growth Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy; D011878:Radiotherapy
chemical_list: D000970:Antineoplastic Agents; D004873:Ergolines; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D019382:Human Growth Hormone; D000069036:Insulin Glargine; D008687:Metformin; D000077465:Cabergoline; C406545:pegvisomant