Ketoacidosis as the initial clinical condition in nine patients with acromegaly: a review of 860 cases at a single institute

Objective: Excess GH causes insulin resistance and impaired glucose metabolism. The objective of this study was to clarify the prevalence of ketoacidosis as the initial presenting symptom of acromegaly. Design and methods: Data were collected from 860 patients with acromegaly who underwent pituitary surgery at Toranomon Hospital over the last 32 years, between 1980 and 2011. Results: Nine cases had ketoacidosis before being diagnosed with acromegaly, including seven males and two females with a mean+/-S.D. age of 38.8+/-14.2 years. Serum GH and IGF1 levels were 155+/-203 ng/ml and 9.86+/-0.68 SDS before pituitary surgery and 3.6+/-1.7 ng/ml and 3.72+/-3.40 SDS after surgery respectively. The maximum tumor diameter was 28.2+/-11.6 mm (ranging from 15 to 47 mm, n=8). None of the patients were diagnosed with diabetes mellitus (DM) nor were they positive for antibodies related to type 1 DM. A possible precipitating factor for ketoacidosis in six cases was excessive ingestion of sugar-containing soft drinks. All the cases had invasive pituitary adenomas. After pituitary surgery, plasma glucose levels were under control without requiring insulin in all cases. Furthermore, six patients did not need oral hypoglycemic agents. Conclusions: Approximately 1% of patients with acromegaly presented with diabetic ketoacidosis as their first clinical condition.