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Acromegaly And Type 1 Diabetes

Elevated Serum Growth Hormone In A Patient With Type 1 Diabetes: A Diagnosticdilemma.

Elevated Serum Growth Hormone In A Patient With Type 1 Diabetes: A Diagnosticdilemma.

1. Diabetes Metab Res Rev. 2000 May-Jun;16(3):211-6. Elevated serum growth hormone in a patient with Type 1 diabetes: a diagnosticdilemma. (1)Department of Diabetes, Western General Hospital, Edinburgh, UK. The biochemical confirmation of acromegaly is rarely difficult and is based on anelevated fasting serum growth hormone (GH) concentration, which fails to suppressin response to an oral glucose load. Impaired glucose tolerance and Type 2diabetes are common in patients with acromegaly, however the development ofacromegaly in a patient with pre-existing Type 1 diabetes has not been welldocumented. Poorly controlled Type 1 diabetes in non-acromegalic patients isassociated with dysregulation of the hypothalamic-GH/insulin-like growth factor-1(IGF-1) axis, leading to elevation of serum GH concentrations. Therefore thediagnosis of acromegaly in a Type 1 diabetic patient may be fraught withpractical difficulties in performing and interpreting the results of an oralglucose tolerance test (OGTT) and other biochemical investigations. When, inaddition, the clinical and radiological features of acromegaly are equivocal, theclinician is faced with a formidable diagnostic challenge. In this paper wereport such a case, review the pathophysiology of hypersomatotrophinaemia inpoorly controlled Type 1 diabetes, and recommend a diagnostic algorithm for theinvestigation of acromegaly in patients with diabetes.Copyright 2000 John Wiley & Sons, Ltd. Continue reading >>

Woman With Type 2 Diabetes And Acromegaly

Woman With Type 2 Diabetes And Acromegaly

Woman With Type 2 Diabetes and Acromegaly Diabetes Type 2 , Atrial Fibrillation , Sleep Disorders , Endocrine Diseases A 43-year-old woman presented with uncontrolled type 2 diabetes mellitus. Her hemoglobin A1c level was 12%, and self-measured glucose levels had been above 400 mg/dL for 3 months. She was taking insulin 70/30, 70 units twice daily. The patient had multiple folds on the scalp, a protruding forehead (Figure 1), a high-arched palate, a large tongue, a protruding jaw with widely spaced teeth (Figure 2), large hands with sweaty palms, and large feet with soft tissue thickening of the soles. Her daughter remarked that her mother's appearance had started to change shortly before her diabetes was diagnosed, 3 years earlier. The patient's growth hormone (GH) level was 55 ng/mL (normal, 0 to 5 ng/mL) and insulinlike growth factor-I (IGF-I) level was above 1000 ng/mL (normal, 90 to 360 ng/mL). These findings confirmed the diagnosis of acromegaly. An MRI scan with gadolinium showed a 19.74-mm macroadenoma that had eroded the inferior wall of the sella turcica; the tumor extended into the sphenoid sinus (Figure 3). There was no evidence of optic chiasmal compression. Acromegaly is rare; the annual estimated incidence is 3 to 4 cases per 1 million persons. It is characterized by hypersecretion of GH, which in more than 95% of patients results from a pituitary somatotroph adenoma.1 Clinical features. This patient had the classic clinical findings of advanced acromegaly, namely the enlarged facial features, head, hands, and feet. Because the disease is insidious, a formal diagnosis may be delayed up to 10 years.1 The symptoms of local tumor growth may include headache, visual field loss, and cranial nerve palsies.1 This patient had none of these symptoms. The changes Continue reading >>

Cases Of Diabetic Ketoacidosis As An Initial Presentation Of Acromegaly

Cases Of Diabetic Ketoacidosis As An Initial Presentation Of Acromegaly

Cases of diabetic ketoacidosis as an initial presentation of acromegaly Veteran Affairs Medical Center and Broadlawns Medical Center, Des Moines, USA Des Moines University of Osteopathic Medicine, Des Moines, USA Adjunct Professor of Medicine and Endocrinology, University of Iowa, USA Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus especially of type 1 variety often requiring hospitalization. Herein we report 2 subjects with Acromegaly who presented with DKA as the initial manifestation. In one subject, total remission from diabetes occurred following successful resection of growth hormone secreting pituitary adenoma localized to pituitary fossa without onset of hypopituitarism. In the other subject, total remission of diabetes ensued only after administration of somatostatin (Sandostatin LAR) once a month for 6 months since a complete resection of pituitary adenoma could not be performed due to suprasellar extension and hypopituitarism requiring treatment persisted after surgery. Diabetic ketoacidosis (DKA) occurs as an acute metabolic derangement in subjects with diabetes Mellitus. The common metabolic abnormalities include markedly increased concentrations of ketone bodies, e.g. beta hydroxybutyrate, acetoacetate and acetone in the circulation with concurrent hyperglycemia. DKA is a serious and potentially life threatening complication. Predisposing factors include new-onset type 1 diabetes, insulin withdrawal and onset of acute illness [1-6]. In this report, we describe 2 subjects who presented DKA as initial manifestation of acromegaly secondary to growth hormone producing pituitary adenomas and total remission following resection in one and surgery followed by treatment with Sandostatin in the other A 56-year-old Caucasian man was admitted with Continue reading >>

A Case Of Latent Autoimmune Diabetes In Adults Developed After Surgical Cure Of Growth Hormone Secreting Pituitary Tumor

A Case Of Latent Autoimmune Diabetes In Adults Developed After Surgical Cure Of Growth Hormone Secreting Pituitary Tumor

Your browser does not support the NLM PubReader view. Go to this page to see a list of supporting browsers. A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor Endocrinol Metab. 2012 Dec;27(4):318-322. Endocrinol Metab. 2012 Dec;27(4):318-322. Korean. Published online December 20, 2012. Copyright 2012 Korean Endocrine Society A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor Wonjin Kim,1Jung Ho Kim,1Youngsook Kim,1Ji Hye Huh,1Su Jin Lee,1Mi Sung Park,1Eun Yeong Choe,1Jeong Kyung Park,2Myung Won Lee,3Jae Won Hong,1,4Byung Wan Lee,1,4,5Eun Seok Kang, 1,4,5Bong Soo Cha,1,4,5Eun Jig Lee,1,4 and Hyun Chul Lee1,4,5 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 2Institute of Endocrinology, Goodmorning Hospital, Pyeongtaek, Korea. 3Institute of Endocrinology, Gwangmyung Sungae Hospital, Gwangmyeong, Korea. 4Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea. 5Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. Corresponding author: Eun Seok Kang. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea. Tel: +82-2-2228-1968, Fax: +82-2-393-6884, Email: [email protected] Received January 03, 2012; Accepted June 05, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It i Continue reading >>

A Young Female Of Acromegaly Presenting With Diabetic Ketoacidosis (dka) | 26312

A Young Female Of Acromegaly Presenting With Diabetic Ketoacidosis (dka) | 26312

Acromegaly is a clinical condition where there is an excess growth hormone levelsusually due to a pituitary adenoma with overt diabetes seen in 10-25%, DKA israre but recognized complication. A 17 years old female came to emergency with historyof thirst, polyuria, weight loss of 10 kg, and loss of consciousness for 2 days.Physicalexamination revealed fi ndings suggestive of acromegaly,including coarse facial features,large head with frontal bossing, large hand s and feet,prominent jaws, macroglossia,gapin lower incisor teeth.Other systemic examinations were normal. Labarotary parametesshowed metabolic acidosis with serum ketone positive, fasting blood sugar 438mg/dl,Post Prandial blood sugar 504mg/dl, HBA1C 15%, TFT were normal but L.H,F.S.Hand serum Prolactin were increased. IGF-1 levels and Growth hormone (GH) were notdone. X-ray- hand along with wrist and X-ray lateral view of skull showed enlarged bonyand soft tissue shadow with joint erosions and osteopenia and enlarged sella tursica. MRIhead showed homogenously enlarged pituitary gland with minimal suprasellar extensionalong with widening of pituitary fossa suggestive of macroadenoma. During the hospitalstay patient blood sugar and DKA was controlled with insulin, fl uids and electrolytebalance. She had attempted suicide twice due to social reasons and embarrassmentworking with peer groups, diffi culty getting enough food as body requirements, poorsocioeconomic status and diffi culty getting medicines.In conclusion, this case shows theimportance of insulin resistance due to growth hormone excess in the presence of relativeinsulin defi ciency as a cause of diabetic ketoacidosis. Dr. Robin Maskey has completed his MBBS at the age of 25 years from Manipal college of Medical Sciences,Pokhara,Nepal and MD Internal Med Continue reading >>

Acromegaly Diagnosis

Acromegaly Diagnosis

Your doctor may suspect that you have acromegaly because of physical changes-your feet and hands may have grown, in addition to facial changes. Some doctors may even ask to see older photographs of you so that they can compare facial features. (You can read more about the physical changes in the article on acromegaly symptoms). However, to make an accurate diagnosis of acromegaly, he or she will need to run some tests. Diagnosing acromegaly involves 2 key blood tests: a test to check the level of the insulin-like growth factor-1 (IGF-1) and an oral glucose tolerance test (OGTT). Doctors can't simply test for the level of growth hormone (GH) in your body because the level varies so much in one day—even in someone without acromegaly. That means that a doctor could randomly test for GH and get a normal level in a person with acromegaly. However, because of GH fluctuations, the doctor could also test GH levels in someone without acromegaly and get a level far above normal. Therefore, doctors rely on IGF-1 and OGTT tests to help diagnose acromegaly. Testing Insulin-like Growth Factor-1 (IGF-1) Insulin-like growth factor-1 (IGF-1) is a hormone that's closely tied to growth hormone. GH tells the body to make IGF-1, which in turn causes tissues in your body to grow. In someone without acromegaly, a high IGF-1 level is the body's signal to stop producing GH. For a person with acromegaly, though, the body continues producing GH, regardless of high IGF-1 levels. IGF-1 levels are much more constant throughout the day than GH levels, so doctors measure IGF-1 levels using a blood test. An elevated IGF-1 level may indicate acromegaly. Oral Glucose Tolerance Test (OGTT) Growth hormone levels and blood glucose levels are also connected. In someone without acromegaly, a higher blood gl Continue reading >>

Acromegaly Presenting With Low Insulin-like Growth Factor-1 Levels And Diabetes: A Case Report

Acromegaly Presenting With Low Insulin-like Growth Factor-1 Levels And Diabetes: A Case Report

DilushiRowenaWijayaratne 1 Email author , Acromegaly is an endocrine disorder arising from excessive serum growth hormone levels in adulthood and is characterized by progressive somatic enlargement. Biochemical confirmation is achieved by demonstration of elevated baseline serum growth hormone levels which are not suppressed during an oral glucose tolerance test, and by increased levels of serum insulin-like growth factor-1. The serum insulin-like growth factor-1 level provides an assessment of integrated growth hormone secretion and is recommended for diagnosis, monitoring, and screening of acromegaly. We report a case of a patient with acromegaly secondary to a pituitary microadenoma who presented with low insulin-like growth factor-1. An 83-year-old Sinhalese woman presented to our hospital with an enlarging multinodular goiter. She was observed to have macroglossia, thickened coarse skin, acral enlargement, and newly detected, uncontrolled diabetes. A diagnosis of acromegaly was suspected. She did not complain of recent headaches, vomiting, visual difficulties, or galactorrhea and was clinically euthyroid. Her pulse rate was 84 beats/min, and her blood pressure was 150/90 mmHg. A visual field assessment did not reveal a defect. Her random growth hormone levels were 149 mU/L (<10 mU/L), and her oral glucose tolerance test was supportive of acromegaly with a paradoxical rise of growth hormone. Her serum age-specific insulin-like growth factor-1 level was below normal at 124.7 ng/ml (normal range 150350 ng/ml). Her serum insulin-like growth factor-1 level, measured after glycemic control was achieved with metformin and insulin, was elevated, which is characteristic of acromegaly. Magnetic resonance imaging of her pituitary revealed a pituitary microadenoma. Acromegaly Continue reading >>

Acromegaly

Acromegaly

Acromegaly is a rare disease that is due to a growth hormone (GH)-secreting tumor of the pituitary gland. Acromegaly is very rare, with a reported incidence of up to 5 cases per million. It affects men and women equally and is not known to be more common in any race or population from a particular geographic region. The average age at presentation is 40-50 years, but acromegaly can present at all ages. When acromegaly develops before or during puberty, the disease can manifest as gigantism due to the rapid increase in height due to long-bone growth. Nearly all cases are sporadic, but rarely acromegaly is associated with other familial endocrine syndromes (see later). The patient with acromegaly is transformed by the multisystem effects of longstanding exposure to excess growth hormone and IGF-I (insulin-like growth factor 1), a hormone whose production is increased by GH and that mediates most of the growth-promoting effects of GH. The disease cannot be detected on routine laboratory work or by the presence of one of its common comorbidities alone. Rather, a clinical suspicion of the disease is necessary in almost all patients to trigger an investigation for acromegaly. Most patients with acromegaly are recognized because they have enlargement of their hands and feet and classic changes in their facial features. These are present at diagnosis in nearly all patients. On examination, the characteristic facial changes appear as coarsening of the features (enlargement of the lips and nose, deepening of the creases), prominence of the brow, enlargement of the lower jaw and tongue, and increased spacing of the teeth. Patients may relay a history of having their rings enlarged and their shoe size increased, especially its width. These changes can be very marked, often indicat Continue reading >>

Acromegaly | Johns Hopkins Diabetes Guide

Acromegaly | Johns Hopkins Diabetes Guide

-- The first section of this topic is shown below -- A clinical syndrome resulting from excessive secretion of growth hormone (GH). GH excess prior to closure of the epiphyseal plates results in gigantism; after epiphyseal plate closure, the result is acromegaly. Somatic and metabolic effects of chronic GH hypersecretion are predominantly mediated by high levels of insulin-like growth factor-1 (IGF-1). Acromegaly is an uncommon secondary cause of diabetes. Excess GH: 1) stimulates gluconeogenesis and lipolysis, causing hyperglycemia and elevated free fatty acid levels; 2) leads to both hepatic and peripheral insulin resistance, with compensatory hyperinsulinemia. Conversely, IGF-1 increases insulin sensitivity. However, in acromegaly, increased IGF-1 levels are unable to overcome the insulin-resistant state caused by GH excess. -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Ball, Douglas. "Acromegaly." Johns Hopkins Diabetes Guide, Johns Hopkins Guide, 12 July 2018, Accessed 12 July 2018. Ball D. (Published July 12, 2018). Acromegaly. Johns Hopkins Diabetes Guide, Johns Hopkins Guide. Retrieved from Ball, D. Acromegaly. Johns Hopkins Guide. Johns Hopkins Diabetes Guide. Published 2018. Ball D. Johns Hopkins Diabetes Guide [Internet]. c2018. Acromegaly; Johns Hopkins Guide. [cited 2018 July 12]; Available from: Continue reading >>

Payperview: Biochemical Evaluation Of Patients With Active Acromegaly And Type 2 Diabetes Mellitus: Efficacy And Safety Of The Galanin Test - Karger Publishers

Payperview: Biochemical Evaluation Of Patients With Active Acromegaly And Type 2 Diabetes Mellitus: Efficacy And Safety Of The Galanin Test - Karger Publishers

I have read the Karger Terms and Conditions and agree. 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 (2 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 GH 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. Melmed S: Medical progress: Acromegaly. N Engl J Med 2006;355:25582573. Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S: Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000;85:526529. Continue reading >>

The Role Of Diabetes In Acromegaly Associated Neoplasia

The Role Of Diabetes In Acromegaly Associated Neoplasia

The Role of Diabetes in Acromegaly Associated Neoplasia Affiliation: Department of Medicine, Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada Affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada Affiliation: Department of Medicine, University of Montreal, Montral, Qubec, Canada Affiliation: Department of Medicine, Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada Affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada The risk and mortality due to cancer in patients with acromegaly have been previously investigated. Although GH/IGF-1 excess provides a probable pathophysiological explanation, the degree of IGF-1 excess and the role in acromegaly-associated neoplasms of diabetes, a common comorbidity in acromegaly with known association with cancer, remains unclear. Acromegalic patients treated in three Canadian referral centers (Toronto, Montreal, Edmonton) were included. All available clinical information was recorded including: age, initial and last percentage of the upper limit of normal (%ULN) IGF-1 levels, comorbidities and other neoplasms (benign and malignant). 408 cases were assessed. 185 were women (45.3%), 126 (30.9%) developed extra-pituitary neoplasms: 55 malignant and 71 benign. The most frequent anatomic site was the gastrointestinal tract (46 [11.3%]), followed by head and neck (36 [8.8%]) and multiple locations (14 [3.4%]). 106 (26.0%) cases had diabetes. Initial IGF-1 was significantly higher in men older than 50 (380.15 vs. 284.78, p = 0.001) when compared to men younger than 50. Diabetics showed significantly higher initial IGF-1 (389.38 vs. 285.27, p = 0.009), as did diabetics older than 50 compared with thos Continue reading >>

Diagnosis Of Acromegaly In A Patient With Type 1 Diabetes Mellitus.

Diagnosis Of Acromegaly In A Patient With Type 1 Diabetes Mellitus.

Diagnosis of acromegaly in a patient with type 1 diabetes mellitus. Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA. To describe a case of acromegaly in a young patient with poorly controlled diabetes mellitus and suggest guidelines to distinguish acromegaly and high growth hormone (GH) levels previously reported in poorly controlled type 1 diabetes. We present a detailed case report, including clinical findings and serial laboratory results in a patient with type 1 diabetes and a GH-secreting pituitary tumor. A 28-year-old woman with type 1 diabetes underwent assessment for secondary amenorrhea and worsening glycemic control. A low estradiol level and an inappropriately low level of follicle-stimulating hormone prompted magnetic resonance imaging of the head, which demonstrated a pituitary adenoma. Subsequent endocrine investigation revealed a high insulin-like growth factor I (IGF-I) level (849 mg/L; normal range, 122 to 400). The concentration of insulin-like growth factor-binding protein-3 (IGFBP-3) was also elevated (5.5 mg/L; normal range, 2.0 to 4.2). GH levels measured during episodes of spontaneous hyperglycemia (>180 mg/dL) were in the range of 3 to 5 ng/mL and failed to suppress to below 2 ng/mL after a bromocriptine suppression test. The patient underwent transsphenoidal resection of a pituitary tumor, which stained positively for GH by immunohistochemistry. Postoperatively, glycemic control improved, with decreased fluctuations of hypoglycemia and hyperglycemia, despite a decrease in insulin requirements. This report highlights the difficulty in interpreting GH and IGF-I levels in patients with type 1 diabetes. In addition, a detailed review of the literature suggests that IGFBP-3 measurements may be he Continue reading >>

Feline Acromegaly - Endocrine System - Merck Veterinary Manual

Feline Acromegaly - Endocrine System - Merck Veterinary Manual

Acromegaly, or hypersomatotropism, results from chronic, excessive secretion of growth hormone in the adult animal. Acromegaly in cats is caused by a growth hormonesecreting tumor of the anterior pituitary. In cats, these tumors grow slowly and may be present for a long time before clinical signs appear. Feline acromegaly occurs in older (814 yr) cats and appears to be more common in males. Clinical signs of uncontrolled diabetes mellitus are often the first sign of acromegaly in cats; therefore, polydipsia, polyuria, and polyphagia are the most common presenting signs. Net weight gain of lean body mass in cats with uncontrolled diabetes mellitus is a key sign of acromegaly. Organomegaly, including renomegaly, hepatomegaly, and enlargement of endocrine organs, is also seen. Some, but not all, cats show the classic enlargement ofextremities, body size, jaw, tongue, and forehead that is characteristic of acromegaly in people. Some of the most striking manifestations are seen in the musculoskeletal system and include an increase in muscle mass and growth of the acral segments of the body, including the paws, chin, and skull. Stridor may be detected as a result of increased soft-tissue enlargement of the epiglottis and surrounding tissues. Cardiovascular abnormalities such as cardiomegaly (radiographic and echocardiographic), systolic murmurs, and congestive heart failure develop late in the disease course. Azotemia also develops late in the course of the disease in ~50% of acromegalic cats. Neurologic signs of acromegaly in people, such as peripheral neuropathies (paresthesias, carpal tunnel syndrome, sensory and motor defects) and parasellar manifestations (headache and visual field defects), are not generally detected in acromegalic cats. Impaired glucose tolerance and Continue reading >>

Acromegaly Complications

Acromegaly Complications

If left untreated, acromegaly—when your body produces too much growth hormone—can lead to various complications. The most common acromegaly complications involve joint problems, pituitary hormone deficiency, and respiratory problems. It's also possible to develop complications if acromegaly is undertreated, which is why it's so important to work closely with your doctor to monitor hormone levels. Bone Complications from Acromegaly Excess growth hormone (GH) secreted by a tumor (usually a pituitary tumor) can cause your bones to grow too much. Bone overgrowth is especially noticeable in the face, and it can cause problems for your teeth if your jaw grows too much. Unfortunately, it's not possible to reverse this bone overgrowth, but it is possible to stop it by treating acromegaly. To deal with enlarged bones, you may need to have surgery to reshape the bones, but that isn't recommended until your growth hormone and insulin-like growth factor-1 (IGF-1) levels are back in a normal range. Bone health can also be affected by acromegaly. Too much GH can change the way your body uses vitamin D, a vitamin that's absolutely essential for bone health. Without it, your body can't use calcium well, so your bones don't get the calcium they need. This may lead to osteoporosis—low bone density—and that puts you at a higher risk of a fracture. Hypercalcemia (too much calcium in the blood) and hypercalciuria (too much calcium in the urine) are possible complications of acromegaly; both of them mean that your body isn't using calcium. However, with treatment, your body should again be able to properly use vitamin D and calcium to build strong, healthy bones. Soft Tissue Complications from Acromegaly Unlike bone overgrowth, soft tissue changes are often reversible with acromegaly Continue reading >>

Pathogenesis And Clinical Profile Of Diabetes Mellitus In Acromegaly

Pathogenesis And Clinical Profile Of Diabetes Mellitus In Acromegaly

Acromegaly is a condition characterised by oversecretion of growth hormone (GH) from the anterior pituitary gland, most commonly caused by a pituitary tumour. In childhood or adolescence, oversecretion of GH leads to an increase in growth of all bones, resulting in gigantism. If GH oversecretion develops after the epiphyseal plates have fused in the long bones, these cannot grow further; however, continued growth occurs in the bones of the face, hands and feet, resulting in the characteristic features of acromegaly. GH opposes several of the actions of insulin to produce insulin resistance. Overt diabetes mellitus develops in about 20%, and glucose intolerance in about 40%, of patients with acromegaly. Introduction Acromegaly is an endocrine disorder caused by oversecretion of Growth Hormone (GH). In more than 98% of cases this happens due to a GH-secreting pituitary adenoma; in the other cases (less than 2%) it is the result of over-secretion of Growth Hormone Releasing Hormone (GHRH) from a hypothalamic lesion or from a carcinoid tumour of the gut or pancreas [1]. Acromegaly is occasionally found in association with hyperparathyroidism and pancreatic islet cell tumours like glucagonoma, insulinoma & gastrinoma as part of Multiple Endocrine Neoplasia syndrome (MEN) Type 1 [2][3]. The correlation between acromegaly and diabetes was noted as early as 1884 by Loeb [4]. Subsequent studies have shown that the incidence of hyperglycaemia and glycosuria in acromegalic patients may vary between 10-40 % [5]. Overt diabetes mellitus (DM) has been reported in 13-30% of acromegalic patients [6], while impaired glucose tolerance was noted amongst 36% acromegalic patients in another series [7]. Recent data from the French Acromegaly Registry reported a 22.3% incidence of DM in acrom Continue reading >>

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