Diabetic ketoacidosis in a patient with acromegaly and central diabetes insipidus treated with octreotide long-acting release

Abstract

A 43-year-old man was diagnosed with acromegaly due to pituitary GH-secreting macroadenoma, and underwent craniotomy surgery. After surgery, he was given octreotide long-acting release (LAR) to treat the residual tumor. Eighteen months later, he presented polydipsia and polyuria due to diabetic ketoacidosis (DKA) and central diabetes insipidus (CDI). His casual plasma glucose level was 570 mg/dL, his HbA1c was 14.9%, and his urine was strongly positive for ketone bodies. We discuss a causal relationship among DKA, CDI, and treatment with LAR in this case with residual GH-secreting tumor from the perspective of insulin secretion and resistance.

Ketoacidosis, Hypertriglyceridemia and Acute Pancreatitis Induced by Soft Drink Polydipsia in a Patient with Occult Central Diabetes Insipidus

“…CDI combined with DKA has been highlighted in only a small number of case reports (13)(14)(15)(16)(17). If both occur at the same time, it may be difficult to make a precise diagnosis, which can pose a serious threat to a patient's life.…”

“…Anti-rabphilin-3A antibodies are found in the majority of patients with LINH (12). Coexistence of CDI and DKA is rare, with only few published reports, and the causal relationship has not yet been addressed (13)(14)(15)(16)(17).…”

Sodium glucose cotransporter 2 inhibitors treatment in acromegalic patients with diabetes—a case series and literature review

“…We had identi ed 27 acromegalic patients presented with DKA [17,7,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. For the majority of the cases (25 out of 27) DKA was the initial presentation of unrecognized active acromegaly in patients harboring macroadenoma with signi cantly high levels of GH and IGF-1.…”

“…In the rst case, a high dose glucocorticoid administration was considered a precipitating factor for DKA in the presence of consistently elevated GH levels after a partial adenoma resection ]19[. In the second case, a signi cant residual pituitary tumor was not removed, re ecting persistently elevated GH excess [20]. A rapid onset DKA was reported in one patient with unrecognized acromegaly after SGLT2 inhibitor initiation with elevated GH concentration (18.6 mg/L) and high level of IGF-1 (111 nmol/L; age-and sex-speci c reference range, 7 to 31 nmol/L) harboring macroadenoma [7].…”

A 75-Year-Old Woman with a 5-Year History of Controlled Type 2 Diabetes Mellitus Presenting with Polydipsia and Polyuria and a Diagnosis of Central Diabetes Insipidus

“…Co-existing CDI and type 1 diabetes mellitus have been reported in patients with polyglandular autoimmune syndrome [8]. Although the etiological links remain unclear, several cases of CDI with T2D [9][10][11][12][13][14] or diabetes mellitus of other etiologies [15][16][17][18] have been reported.…”