Robin Maskey
Scientific Tracks Abstracts: J Diabetes Metab
Acromegaly is a clinical condition where there is an excess growth hormone levels usually due to a pituitary adenoma with overt diabetes seen in 10-25%, DKA is rare but recognized complication. A 17 years old female came to emergency with history of thirst, polyuria, weight loss of 10 kg, and loss of consciousness for 2 days.Physical examination revealed fi ndings suggestive of acromegaly,including coarse facial features, large head with frontal bossing, large hand s and feet,prominent jaws, macroglossia,gap in lower incisor teeth.Other systemic examinations were normal. Labarotary parametes showed 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.H and serum Prolactin were increased. IGF-1 levels and Growth hormone (GH) were not done. X-ray- hand along with wrist and X-ray lateral view of skull showed enlarged bony and soft tissue shadow with joint erosions and osteopenia and enlarged sella tursica. MRI head showed homogenously enlarged pituitary gland with minimal suprasellar extension along with widening of pituitary fossa suggestive of macroadenoma. During the hospital stay patient blood sugar and DKA was controlled with insulin, fl uids and electrolyte balance. She had attempted suicide twice due to social reasons and embarrassment working with peer groups, diffi culty getting enough food as body requirements, poor socioeconomic status and diffi culty getting medicines.In conclusion, this case shows the importance of insulin resistance due to growth hormone excess in the presence of relative insulin 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 Medicine from B.P.Koirala Institute of Health sciences (BPKIHS),Nepal. He is currently working as Assistant professor in BPKIHS. He is interested in endocrinology and run endocrine clinic once an week.
