[Rare cause of insufficient metabolic control of diabetes mellitus - Case 10/2011].
METHODS
A 48-year-old patient presented with an insufficient control of his diabetes mellitus which was known since 3 years. The antidiabetic medication comprised metformin and exenatide.


METHODS
Physical examination revealed, beside elevated blood pressure, abdominal purple striae. Endocrine testing was consistent with ectopic Cushing's syndrome. Abdominal CT showed a 5 cm measuring, inhomogeneous, contrast-enhanced mass in the right suprarenal area which was positive on iodine-131 MIBG SPECT. Furthermore, urinary catecholamines were markedly increased.


METHODS
Diagnosis of an ACTH-producing pheochromocytoma was made and an open adrenalectomy was performed. Histology confirmed a pheochromocytoma with potential aggressive clinical behaviour according to the Pheocromocytoma of the Adrenal gland Scaled Score. 6 months after the intervention, glucose control was significantly improved with an HbA1c of 5.5%.


CONCLUSIONS
An ACTH-producing pheochromocytoma is a very rare cause of deterioration of glucose control. However, in presence of typical clinical findings an endocrine work-up is warranted.
Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie, Medizinische Universitätsklinik Tübingen.
Katarzyna
K
Dudziak
Ingo
I
Rettig
Patrick
P
Adam
Marius
M
Horger
Hartmut  P
H
Neumann
Karsten
K
Müssig
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D003480:Cushing Syndrome / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D000077270:Exenatide; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014688:Venoms / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D010455:Peptides; D014688:Venoms; D000324:Adrenocorticotropic Hormone; D008687:Metformin; D000077270:Exenatide