title: Refractory DKA as first presentation of acromegaly and a potential role for continuous venovenous hemofiltration in its successful management.
abstract: Diabetic ketoacidosis is rarely encountered in acromegaly. We present a unique patient with refractory diabetic ketoacidosis (DKA) as a first presentation of acromegaly. In addition to an insulin drip and intravenous fluids, our patient was managed with octreotide therapy. As he developed acute renal failure in the context of renal hypoperfusion, continuous venovenous hemofiltration (CVVH) was instituted. After only three days of therapy, the growth hormone (GH) level dropped circa fourfold and insulin growth factor 1 (IGF-1) level dropped ninefold. We postulate a hypothetical role of CVVH in removal of plasma GH and IGF-1, similar to the clearance of other medium size molecules such as brain natriuretic peptide and procalcitonin. If this is confirmed in future studies, CVVH may have therapeutic implications for the above category of patients.
authors: Department of Medicine, University of Connecticut, Farmington, USA.
authors: Prerna
authors: P
authors: Mewawalla
authors: Gayatri
authors: G
authors: Jaiswal
authors: Michael
authors: M
authors: Moustakakis
authors: Niranjan
authors: N
authors: Sankaranarayanan
authors: Constantin A
authors: CA
authors: Dasanu
mesh_terms: D000172:Acromegaly / Q000175:diagnosis* / Q000628:therapy*; D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000503:physiopathology; D006440:Hemofiltration / Q000379:methods*; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide