Cetoacidosis diabética como primera manifestación de un tumor secretor mixto de hormona de crecimiento y prolactina

Coexistence of GH-Producing Pituitary Macroadenoma and Meningioma in a Patient with Multiple Endocrine Neoplasia Type 1 with Hyperglycemia and Ketosis as First Clinical Sign

“…(1) DM with ketosis as its first manifestation: alterations in the metabolism of glucose are a common characteristic in acromegaly, with a described prevalence of DM ranging from 19 to 56% [ 1 – 3 ]. However, these alterations are generally due to the insulin resistance caused by an excess of GH and IGF1, with an increase of gluconeogenesis and a decrease of peripheral glucose uptake [ 4 , 5 ], and it typically does not show a tendency to ketosis, with only 11 cases of ketoacidosis having been described as the first sign of acromegaly [ 4 ]. Some authors have analyzed the factors which may predispose to alterations in the glucose metabolism of these patients, and they are related to the levels of IGF1 [ 1 ], GH [ 6 ], age, body mass index, arterial hypertension, and time of evolution of the disease [ 2 , 3 , 6 ].…”

“…In our case, hyperprolactinemia, due to the compression of the pituitary stalk, may have also contributed to the alteration in glucose metabolism through an increase in insulin resistance. Some of the mechanisms suggested to explain this include a decrease in insulin receptors and/or deficiencies at a postreceptor level [ 4 ]. McCallum et al identified an increased prevalence of diabetes and glucose intolerance in patients with MEN1, and several theories have been put forward in which adiponectin and enteropancreatic markers might be involved, or the MEN1 gene, which may cause a predisposition to this resistance [ 7 ].…”