Diabetic ketoacidosis in acromegaly; a rare complication precipitated by corticosteroid use

Weiss, Jeremy; Wood, A. K. W.; Zajac, Jeffrey D; Grossmann, Mathis; Andrikopoulos, Sofianos; Ekinci, Elif I

doi:10.1016/j.diabres.2017.08.023

Cited by 7 publications

(9 citation statements)

References 37 publications

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“…In the study of Yoshida et al [21]. DKA was reported as an initial manifestation in nine patients with unrecognized, active acromegaly with marked elevation in mean GH (SD) levels 155 ± 203 ng/ml (range, 11-606 ng/mL) and IGF-1(SD) levels 982 ± 98 ng/mL (range, 804-1082 ng/mL) (19), while in our case series, treatment with SGLT2i was initiated in nine patients with already recognized and treated acromegaly with a mean GH (SD) levels 0.7 ± 0.5 µg/L and IGF-1 (SD) levels 177 ± 68 before SGLT-2i initiation. Normalized IGF-1 was reported in 8 out of 9 patients (table 2).…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2021

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PurposeDiabetes mellitus (DM) represents one of the most frequent comorbidities in patients with acromegaly. Sodium glucose cotransporter 2 inhibitors (SGLT2i) represent an important class for diabetes management. However, limited data is reported regarding the use of this class in patients with acromegaly and diabetes. MethodsReporting data regarding patients with acromegaly and diabetes under treatment with SGLT2i. Results34 acromegalic patients with diabetes were identi ed. Treatment with SGLT-2i was documented in nine patients, out of them 5 females and 4 males with a mean age (SD) of 61± 12 yr. The mean (SD) duration of treatment with SGLT2i was 27.5 ± 7.3 months. Mean HbA1c before and after SGLT-2i initiation was 8.1 ± 1.1% and 7.0 ± 0.9% respectively. Mean IGF-1 level (SD) before SGLT-2i initiation was 177 ± 68 ng/mL and the mean GH level (SD) was 0.7 ± 0.5 µg/L. All nine patients are still under treatment with SGLT2i and none of them had reported any adverse reaction related to SGLT2i. ConclusionsThe present article provides us for the rst time with new data regarding the use of SGLT2i among acromegalic patients with diabetes.

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Section: Discussionmentioning

confidence: 97%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…It was likely due to a combination of severe insulin resistance from acromegaly and impaired insulin secretion (or relative insulin deficiency) from chronic undiagnosed hyperglycemia. Although there are a few reports of DKA as a complication of acromegaly, 6 , 7 the association was not well established.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the insulin response to carbohydrate exposure is decreased, 14 which could result in DKA. 6,7 Islet cells may undergo progressive changes when exposed to prolonged high levels of GH, which could result in cell degeneration, a reduction in insulin production, and finally DKA. 22 However, this mechanism has been borne out only in animal studies.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetic ketoacidosis (DKA) is both a potentially deadly hyperglycemic crisis and one of the most common causes of diabetes-related hospitalization in the U.S. 1,2 DKA currently is not established as a complication of acromegaly, [3][4][5] even though many authors have described their association. 6,7 This case reports a middle-aged male patient with a long history of untreated acromegaly who developed DKA.…”

Section: Introductionmentioning

confidence: 98%

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Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review

Delgado

Valverde

Vaca³

2022

kjm

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Secondary diabetes mellitus in acromegaly

et al. 2023

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Secondary diabetes mellitus (DM) is a common complication of acromegaly, encountered in up to 55% of cases. Vice versa, the prevalence of acromegaly is markedly higher in cohorts of patients with type 2 DM (T2DM). The presence of secondary DM depends primarily on acromegaly status and is associated with increased cardiovascular morbidity, malignancy rate and overall mortality. The principal pathophysiologic mechanism is increased insulin resistance due to excessive lipolysis and altered fat distribution, reflected at the presence of intermuscular fat and attenuated, dysfunctional adipose tissue. Insulin resistance is ascribed to the direct, diabetogenic effects of growth hormone (GH), which prevail over the insulin-sensitizing effects of insulin-like growth factor 1 (IGF-1), probably due to higher glucometabolic potency of GH, IGF-1 resistance, or both. Inversely, GH and IGF-1 act synergistically in increasing insulin secretion. Hyperinsulinemia in portal vein leads to enhanced responsiveness of liver GH receptors and IGF-1 production, pointing towards a mutually amplifying loop between GH-IGF-1 axis and insulin. Secondary DM occurs upon beta cell exhaustion, principally due to gluco-lipo-toxicity. Somatostatin analogues inhibit insulin secretion; especially pasireotide (PASI) impairs glycaemic profile in up to 75% of cases, establishing a separate pathophysiologic entity, PASI-induced DM. In contrast, pegvisomant and dopamine agonizts improve insulin sensitivity. In turn, metformin, pioglitazone and sodium-glucose transporters 2 inhibitors might be disease-modifying by counteracting hyperinsulinemia or acting pleiotropically. Large, prospective cohort studies are needed to validate the above notions and define optimal DM management in acromegaly.

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Diabetic ketoacidosis in acromegaly; a rare complication precipitated by corticosteroid use

Cited by 7 publications

References 37 publications

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

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

Diabetic Ketoacidosis in Undiagnosed Acromegaly: A Case Report and Literature Review

Secondary diabetes mellitus in acromegaly

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