Diagnosis of Acromegaly in A Patient with Type 1 Diabetes Mellitus

Hofmann, E.; Polonsky, Kenneth S.; Weiss, Roy E.

doi:10.4158/ep.8.2.113

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…The diagnosis of acromegaly can be further complicated by interpreting GH and IGF-1 levels in the presence of insulin-dependent and non-insulin dependent diabetes 5 6. Evidently, an undiagnosed or overlooked state of hyperglycaemia can cloud the true results of an oral glucose tolerance test.…”

Section: Discussionmentioning

confidence: 99%

What the mind knows but the eyes may still miss: reducing the ‘Acromegalic Window’

Foucault

2014

BMJ Case Reports

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A 46-year-old Asian man was referred to our endocrine unit (April 2013) by his general practitioner for investigation of a neck mass. Ultrasound scan of the neck and serum thyroid-stimulating hormone levels revealed a euthyroid multinodular goitre. He presented with symptoms of frequent headaches, polydypsia, polyuria, perspiration and night sweats and demonstrated classic physical features of acromegaly. In retrospect, the patient's medical history included encounters with numerous physicians from an array of specialties for over 20 years, mostly for symptoms well recognised to be attributed to growth hormone (GH) excess. Random insulin-like growth factor-1 level was elevated at 103 nmol/L (normal 13-37 nmol/L) and oral glucose tolerance test showed non-suppressible GH secretion (15.06 mIU/L at 120 min). MRI revealed a mildly enlarged pituitary gland. The patient has been referred for surgery. This case highlights that, even with classic features of acromegaly, there may be a wide-ranging 'Acromegalic Window' between first presentation and clinical suspicion to eventual diagnosis.

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Section: Discussionmentioning

confidence: 99%

What the mind knows but the eyes may still miss: reducing the ‘Acromegalic Window’

Foucault

2014

BMJ Case Reports

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“…Type 2 diabetes mellitus is a frequent complication of acromegaly, occurring in about 20–40% of patients with the disease [4, 5]. Previous studies have pointed out that the diagnosis of acromegaly may be difficult in patients with diabetes mellitus, mainly when the physical findings are subtle [13, 14]. In particular, serum GH and IGF-1 values are not easily interpreted in patients with diabetes mellitus [6,7,8,9,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, magnetic resonance evidence of a pituitary adenoma is not helpful in the diagnostic decision, especially after neurosurgical intervention which causes structural modifications of the pituitary sella [12]. Therefore, the diagnosis of active acromegaly in patients with diabetes mellitus could be a real clinical dilemma [13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Biochemical Evaluation of Patients with Active Acromegaly and Type 2 Diabetes Mellitus: Efficacy and Safety of the Galanin Test

Mazziotti

Bonadonna²,

Doga³

et al. 2008

Neuroendocrinology

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The oral glucose tolerance test, which is considered the gold standard for the diagnosis of active acromegaly, should not be performed in the presence of basal hyperglycemia. Moreover, false-positive responses may occur in patients with diabetes mellitus. Galanin has previously been demonstrated to induce paradoxical inhibition of growth hormone (GH) secretion in most patients with active acromegaly. In this study, we assessed GH response to galanin infusion in a series of 17 consecutive patients with active acromegaly, 7 of whom had coexistent type 2 diabetes mellitus and 10 were without either diabetes mellitus or impaired tolerance to glucose. 6 acromegalic patients with diabetes mellitus (85.7%) and 7 without diabetes (70.0%) showed a decrease in serum GH values during galanin infusion (χ² 0.9; p = 0.6). The GH nadir occurred at a comparable time in the two groups of acromegalic patients. Moreover, the two groups showed no significant difference (p = 0.45) in ΔGH during galanin infusion. Galanin infusion did not induce any significant change in plasma glucose levels in both diabetic and non-diabetic patients with acromegaly. The results of our study provide evidence that the galanin test may be of value for the diagnosis of acromegaly in patients with type 2 diabetes mellitus.

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“…The diagnostic evaluation of acromegaly is undertaken by noting clinical symptoms, high blood levels of GH and IGF-1, and the existence of a pituitary tumor seen in MRIs [2]. The measurements of serum IGF-1 or IGFBP-3 have been reported as being more valuable for diagnosing acromegaly in type 1 diabetes than a single measurement of GH [7,8]. In the present case, although blood IGFBP-3 levels were always within the normal range, blood levels of GH and IGF-1 were frequently high and a mass was observed on pituitary MRI.…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of serum IGF-1 and IGF-binding protein-3 (IGFBP-3) has been reported as being valuable for the diagnosis of acromegaly in type 1 diabetes [7,8]. However, it may be sometimes difficult to diagnose acromegaly associated with type 1 diabetes because insulin, GH and IGF-1 may mutually interfere with each other on secretion [9].…”

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confidence: 99%

Type 1 Diabetes Associated with Asymptomatic Acromegaly Successfully Treated with Surgery after Pregnancy: A Case Report

Iwai

Ito

et al. 2005

Endocr J

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Abstract. We report a rare case of type 1 diabetes in a woman associated with acromegaly who was treated with surgery after pregnancy. An 18-year-old woman came to our hospital in April, 1998, complaining of thirst, polydipsia, polyuria, appetite loss, body weight loss of 8 kg in a month, and amenorrhea beginning 2 months earlier. Based on laboratory data, she was diagnosed as having type 1 diabetes mellitus. Although we suspected her of having acromegaly because of high growth hormone (GH) levels (6.9 or 8.5 ng/ml), blood levels of insulin-like growth factor 1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) were within normal range and the circadian rhythm of her blood GH levels was normally maintained. Her blood GH level was elevated to 12.6 ng/ml 15 minutes after a TRH administration. Blood GH levels were suppressed from 49 ng/ml to 1.5 ng/ml 4 hours after an oral administration of 2.5 mg of bromocriptine. A magnetic resonance images (MRIs) showed pituitary swelling, but no nodules were found in the pituitary. Therefore, we diagnosed her as having acromegaly and observed her without surgery, while prescribing diet therapy and intensive insulin therapy for diabetes. We started a treatment of oral administration of 7.5 mg of bromocriptine per day for the acromegaly from April 28, 2000, because her elevated GH was suspected of causing her diabetes to be poorly controlled. During a pregnancy from October, 2000 to September, 2001, diabetic control was improved with increased administration of insulin under a constant dose of bromocriptine. She delivered a normal full-term infant. After the bromocriptine therapy was stopped as she hoped to breastfeed, blood levels of GH and IGF-1 became elevated and her diabetic control deteriorated. As her pituitary tumor observed in pituitary MRIs became larger during the course, a transsphenoidal surgery was performed on March 8, 2002. After the surgery, blood levels of GH and IGF-1 lowered and diabetic control improved again. We concluded as follows: to rule out acromegaly in patients with poorly controlled diabetes, 1) measurements of serum GH and IGF-1 should be performed, and 2) pituitary MRIs should be performed if blood levels of GH or IGF-1 are high.

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Diagnosis of Acromegaly in A Patient with Type 1 Diabetes Mellitus

Cited by 4 publications

References 28 publications

What the mind knows but the eyes may still miss: reducing the ‘Acromegalic Window’

What the mind knows but the eyes may still miss: reducing the ‘Acromegalic Window’

Biochemical Evaluation of Patients with Active Acromegaly and Type 2 Diabetes Mellitus: Efficacy and Safety of the Galanin Test

Type 1 Diabetes Associated with Asymptomatic Acromegaly Successfully Treated with Surgery after Pregnancy: A Case Report

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