title: Pituitary gigantism presenting with depressive mood disorder and diabetic ketoacidosis in an Asian adolescent.
abstract: Hyperglycemia is seldom described in young patients with pituitary gigantism. Here, we describe the case of a 17-year-old Taiwanese boy who developed depressive mood disorder and diabetic ketoacidosis (DKA) at the presentation of pituitary gigantism. The boy complained of lethargy and dysphoric mood in June 2008. He presented at the emergency department with epigastralgia and dyspnea in January 2009. Results of laboratory tests suggested type 1 diabetes mellitus with DKA. However, serum C-peptide level was normal on follow-up. Although he had no obvious features of acral enlargement, a high level of insulin-like growth factor 1 was detected, and a 75 g oral glucose suppression test showed no suppression of serum growth hormone levels. A pituitary macroadenoma was found on subsequent magnetic resonance imaging. The pituitary adenoma was surgically removed, followed by gamma-knife radiosurgery, and Sandostatin long-acting release treatment. He was then administered metformin, 500 mg twice daily, and to date, his serum glycohemoglobin has been <7%.
authors.forename: Sheng-Fong
authors.initials: SF
authors.lastname: Kuo
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Chuang
authors.forename: Sohching
authors.initials: S
authors.lastname: Ng
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Chen-Nen
authors.initials: CN
authors.lastname: Chang
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Chou
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Weng
authors.forename: Chih-Hua
authors.initials: CH
authors.lastname: Yeh
authors.forename: Jen-Der
authors.initials: JD
authors.lastname: Lin
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D000293:Adolescent; D041923:Adolescent Development; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000209:etiology*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D003937:Diagnosis, Differential; D005877:Gigantism / Q000175:diagnosis* / Q000523:psychology; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D016634:Radiosurgery; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007004:Hypoglycemic Agents; D008687:Metformin; D015282:Octreotide