Diagnosis of acromegaly in a patient with type 1 diabetes mellitus

Elisa A. Hofmann, Kenneth S. Polonsky, Roy E Weiss

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: 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. Methods: 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. Results: 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 μg/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. Conclusion: 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 helpful in confirming the diagnosis of concurrent acromegaly and distinguishing it from high GH levels attributable to poor control of diabetes.

Original languageEnglish (US)
Pages (from-to)113-118
Number of pages6
JournalEndocrine Practice
Volume8
Issue number2
StatePublished - 2002
Externally publishedYes

Fingerprint

Acromegaly
Type 1 Diabetes Mellitus
Growth Hormone
Pituitary Neoplasms
Insulin-Like Growth Factor Binding Protein 3
Insulin-Like Growth Factor I
Hyperglycemia
Reference Values
Bromocriptine
Amenorrhea
Follicle Stimulating Hormone
Hypoglycemia
Estradiol
Diabetes Mellitus
Immunohistochemistry
Head
Magnetic Resonance Imaging
Guidelines
Insulin

ASJC Scopus subject areas

  • Endocrinology

Cite this

Diagnosis of acromegaly in a patient with type 1 diabetes mellitus. / Hofmann, Elisa A.; Polonsky, Kenneth S.; Weiss, Roy E.

In: Endocrine Practice, Vol. 8, No. 2, 2002, p. 113-118.

Research output: Contribution to journalArticle

Hofmann, EA, Polonsky, KS & Weiss, RE 2002, 'Diagnosis of acromegaly in a patient with type 1 diabetes mellitus', Endocrine Practice, vol. 8, no. 2, pp. 113-118.
Hofmann, Elisa A. ; Polonsky, Kenneth S. ; Weiss, Roy E. / Diagnosis of acromegaly in a patient with type 1 diabetes mellitus. In: Endocrine Practice. 2002 ; Vol. 8, No. 2. pp. 113-118.
@article{da65e9f27b3b4f49a081d445f9283006,
title = "Diagnosis of acromegaly in a patient with type 1 diabetes mellitus",
abstract = "Objective: 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. Methods: 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. Results: 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 μg/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. Conclusion: 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 helpful in confirming the diagnosis of concurrent acromegaly and distinguishing it from high GH levels attributable to poor control of diabetes.",
author = "Hofmann, {Elisa A.} and Polonsky, {Kenneth S.} and Weiss, {Roy E}",
year = "2002",
language = "English (US)",
volume = "8",
pages = "113--118",
journal = "Endocrine Practice",
issn = "1530-891X",
publisher = "American Association of Clinical Endocrinology",
number = "2",

}

TY - JOUR

T1 - Diagnosis of acromegaly in a patient with type 1 diabetes mellitus

AU - Hofmann, Elisa A.

AU - Polonsky, Kenneth S.

AU - Weiss, Roy E

PY - 2002

Y1 - 2002

N2 - Objective: 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. Methods: 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. Results: 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 μg/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. Conclusion: 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 helpful in confirming the diagnosis of concurrent acromegaly and distinguishing it from high GH levels attributable to poor control of diabetes.

AB - Objective: 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. Methods: 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. Results: 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 μg/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. Conclusion: 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 helpful in confirming the diagnosis of concurrent acromegaly and distinguishing it from high GH levels attributable to poor control of diabetes.

UR - http://www.scopus.com/inward/record.url?scp=0036127605&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036127605&partnerID=8YFLogxK

M3 - Article

C2 - 11942776

AN - SCOPUS:0036127605

VL - 8

SP - 113

EP - 118

JO - Endocrine Practice

JF - Endocrine Practice

SN - 1530-891X

IS - 2

ER -