Domino effect of pituitary growth hormone tumor complicated by diabetic ketoacidosis and pituitary apoplexy: a case report

Abstract

Background Patients with growth hormone (GH)-secreting adenoma usually develop glucose intolerance. GH increases metabolic rate and, when secreted aberrantly, may result in metabolic syndrome. Herein, we examine the associations of pituitary tumor-induced secretion of hormone with insulin resistance and metabolic syndrome, and determine the relation of pituitary tumor apoplexy-induced diabetic ketoacidosis (DKA) and acute pancreatitis. Case presentation A 44-year-old male with a history of hypertension presented to the emergency department of our hospital on February 14, 2019 with symptoms of headache, dizziness, and vomiting. Computed tomography of the head revealed pituitary tumor with bleeding. An ultrasound scan of the abdomen revealed fatty liver and acute pancreatitis. Further examination revealed the presence of DKA, hypertriglyceridemia, cortical hypofunction crisis and acute kidney injury. Surgical endoscopic resection of the pituitary tumor resection via the transsphenoidal approach was performed. The patient’s postoperative recovery was remarkable. Conclusions Long-term growth hormone abnormality may trigger insulin resistance, leading to metabolic syndrome and impaired glucose and lipid metabolism. The pituitary adenoma apoplexy may also directly induce DKA, creating a domino effect, which further deteriorate the aberrant metabolism of glucose and lipids.

Diabetic ketoacidosis and loss of consciousness as the first clinical presentations of apoplexy in a patient with recurrent pituitary adenoma: A Case Report study

“…Simultaneous DKA and hypophysial apoplexy have made our case a challenging and critical one with great concern; only a few reports are available in the literature on the coexistence of these two conditions (13,14). Hypophysial apoplexy is an acute haemorrhage or infarct with usually unknown etiology in a hypophysial adenoma which depending on the severity, can be managed either surgically, medically, or conservatively (15,16).…”

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

“…One case of gigantism (+5 SD) was reported on a 9-year-old boy with lactosomatotroph PitNET [ 32 ]. Hypopituitarism included elements of hypogonadism [ 127 , 128 , 129 , 131 , 135 ] like disturbances of menstrual cycle in women of reproductive age [ 171 , 172 ], etc., but, also, with a more severe potential, hypotension [ 29 , 48 , 83 , 199 , 210 , 213 ].…”

“…Other signs and symptoms at PA presentation include lactotroph PitNET-associated galactorrhea [ 141 , 174 , 183 ]; hyperthermia [ 180 ], pruritic skin rash associated with central adrenal insufficiency-related cortisol deficit [ 185 ], hiccups [ 109 ], epistaxis [ 91 ], hematuria [ 189 ], phonophobia [ 78 ], visual illusions [ 45 ], and symptomatic diabetic ketoacidosis [ 53 , 171 , 172 ].…”

“…In terms of the PitNET stain profile (regardless clinical expression) non-functional type was followed by somatotroph PitNETs [ 32 , 38 , 42 , 46 , 53 , 56 , 66 , 76 , 78 , 86 , 92 , 93 , 98 , 100 , 108 , 109 , 121 , 128 , 136 , 141 , 148 , 152 , 156 , 166 , 168 , 169 , 171 , 175 , 192 , 217 ], lactotroph PitNETs [ 66 , 75 , 77 , 90 , 98 , 100 , 113 , 121 , 126 , 128 , 141 , 166 , 168 , 169 , 174 , 175 , 183 , 202 , 206 ], gonadotroph PitNETs […”

“…Our decade-based analysis showed that high blood pressure may be regarded as the most frequent co-morbidity (or risk factor) followed by diabetes mellitus in individuals admitted for PA. ( Table 1 ) Two cases reported severe, complicated diabetes with diabetic ketoacidosis [ 53 , 171 , 172 ], and chronic kidney failure [ 59 ]. Another endocrine contributor was T3 thyrotoxicosis in one patient [ 71 ].…”