title: Ketoacidosis as the initial clinical condition in nine patients with acromegaly: a review of 860 cases at a single institute.
abstract: OBJECTIVE
  Excess GH causes insulin resistance and impaired glucose metabolism. The objective of this study was to clarify the prevalence of ketoacidosis as the initial presenting symptom of acromegaly.
  
  
  METHODS
  Data were collected from 860 patients with acromegaly who underwent pituitary surgery at Toranomon Hospital over the last 32 years, between 1980 and 2011.
  
  
  RESULTS
  Nine cases had ketoacidosis before being diagnosed with acromegaly, including seven males and two females with a mean +/- S.D. age of 38.8 +/- 14.2 years. Serum GH and IGF1 levels were 155 +/- 203 ng/ml and 9.86 +/- 0.68 SDS before pituitary surgery and 3.6 +/- 1.7 ng/ml and 3.72 +/- 3.40 SDS after surgery respectively. The maximum tumor diameter was 28.2 +/- 11.6 mm (ranging from 15 to 47 mm, n=8). None of the patients were diagnosed with diabetes mellitus (DM) nor were they positive for antibodies related to type 1 DM. A possible precipitating factor for ketoacidosis in six cases was excessive ingestion of sugar-containing soft drinks. All the cases had invasive pituitary adenomas. After pituitary surgery, plasma glucose levels were under control without requiring insulin in all cases. Furthermore, six patients did not need oral hypoglycemic agents.
  
  
  CONCLUSIONS
  Approximately 1% of patients with acromegaly presented with diabetic ketoacidosis as their first clinical condition.
authors.affiliation: Division of Endocrinology and Metabolism, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yoshida
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Goto
authors.forename: Hisanori
authors.initials: H
authors.lastname: Suzuki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nagasawa
authors.forename: Akira
authors.initials: A
authors.lastname: Takeshita
authors.forename: Minoru
authors.initials: M
authors.lastname: Okubo
authors.forename: Megumi
authors.initials: M
authors.lastname: Miyakawa
authors.forename: Yasumichi
authors.initials: Y
authors.lastname: Mori
authors.forename: Noriaki
authors.initials: N
authors.lastname: Fukuhara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishioka
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeuchi
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology; D000236:Adenoma / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002253:Carbonated Beverages / Q000009:adverse effects; D005260:Female; D006801:Humans; D007662:Ketosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D015985:Precipitating Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose