Status epilepticus and diabetes ketoacidosis: uncommon clinical presentations of acromegaly

Abstract

Summary Acromegaly is a rare disease caused by hypersecretion of the growth hormone (GH). Most cases are caused by either pituitary microadenoma or macroadenoma. The GH producing tumors present with clinical manifestations of acromegaly due to excessive GH secretion or symptoms resulting from mass effects of the enlarging tumor. The physical changes are usually slow and, therefore, recognition of the disease is delayed. These adenomas are never malignant but can have significant morbidity and mortality. A subgroup of patients with acromegaly present with severe hyperglycemia resulting in diabetic ketoacidosis (DKA) which requires insulin. Rarely are pituitary tumors responsible for generalized convulsions except when they are too large. We hereby present two cases, the first is that of a 26-year-old female who presented with new onset status epilepticus, DKA with a 1-year history of diabetes mellitus (DM). On examination, she had clinical features of acromegaly. The second case is that of a 34-year-old female who presented with new onset status epilepticus, hyperglycemia with a history of recently diagnosed DM, and features of gigantism. In both cases, their diagnosis was confirmed by elevated serum GH and later by elevated insulin-like growth factor type 1 levels, and CT of the head demonstrating large pituitary macroadenoma. The importance of clinical history and examination, as well as investigations is vital in the recognition of acromegaly. The prognosis of acromegalic patients depends on early clinical recognition and tumor size reduction by either medical or surgical therapy. Learning points Conditions such as status epilepticus and DKA may be clinical presentations in patients presenting with acromegaly. Seizures are rare in people with pituitary adenoma and typically occur when the tumor invades the suprasellar area due to mass effect on the brain. This article shows how best we were able to manage the acromegaly complications in a low resource setting. Hyperprolactinemia in acromegaly may be due to disruption of the normal dopaminergic inhibition of prolactin secretion due to mass effect of the macroadenoma, and around 25% of GH-secreting adenomas co-secrete prolactin.

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

“…Still, the occurrence of DKA is very uncommon in these patients (6). Limited evidence about DKA in patients with acromegaly is mostly about patients diagnosed with DKA as the first clinical presentation (7,8). The mainstay of DKA management in the acromegalic patient is not different from other cases of DKA; intravenous insulin therapy and hydration are the cornerstones (9, 10) and evidence supporting continuous venovenous hemofiltration in non-responders (11).…”

“…The definite treatment strategy for acromegaly-induced DM is tumor resection; however, appropriate medical management is also necessary in some cases (12). Identical to other DKA cases, headache, nausea, vomiting, and abdominal pain with high BS are the most common clinical presentations (8).…”