title: Diabetic Ketoacidosis in Acromegaly: A Case Report.
abstract: OBJECTIVE
  To report an uncommon case of diabetic ketoacidosis in a patient with acromegaly, and present the clinical response to treatment.
  
  
  METHODS
  Patient evaluation and literature review.
  
  
  RESULTS
  A 23-year-old Japanese male with no prior medical history, presented with diabetic ketoacidosis (DKA) and found to have acromegaly. His growth hormone (GH) level was 115 ng/ml, serum insulin-like growth factor-1 (IGF-1) was 1118 ng/ml, and cranial MRI showed a non-enhancing 2.4 x 1.7 x 2.0 cm pituitary mass. After transphenoidal hypophysectomy, his GH level decreased but his IGF-1 level remained unchanged, yet he required no anti-hyperglycemic medications and attained near normal A1c level of 5.8%. He subsequently underwent stereotactic radiotherapy, and additional treatment with bromocriptine and octreotide acetate were not effective, but pegvisomant therapy lowered his IGF-1 concentration to targeted levels.
  
  
  CONCLUSIONS
  The cause of DKA in this patient with acromegaly is most likely due to glucotoxicity and lipotoxicity, which cause severe but partially reversible β-cell dysfunction; possibly categorized within the syndromes of Ketosis-Prone Diabetes Mellitus (KPD). Diabetic ketoacidosis is an uncommon initial presentation of acromegaly. Successful reduction of GH excess appears to control and resolve hyperglycemia.
authors.affiliation: 1 Department of Medicine, John A. Burns School of Medicine, University of Hawaii-Manoa.
authors.forename: Pilaiporn
authors.initials: P
authors.lastname: Palakawong
authors.forename: Richard
authors.initials: R
authors.lastname: Arakaki