Abstract
A 36-year-old woman had been aware of changes in her facial features since approximately 2006 (at 33 years of age). A sense of excessive thirst manifested in 2008 (at 35 years of age); however, it was left untreated. The patient developed a fever of 37.3 °C, nausea and epigastric pain in January 2009 (at 36 years of age) and presented to our hospital the following day. Her blood glucose level was 645 mg/dl. Metabolic acidosis (pH: 7.144, HCO3-: 3.8 mmol/l, PCO2: 11.4 mmHg) with a high anion gap (31.2 mEq/l) was detected and the urinary ketone body concentration was 3+. Diabetic ketoacidosis was diagnosed. The patient had acromegalic facial features and high levels of growth hormone (260 ng/ml) and insulin-like growth factor-1 (1,047 ng/ml). A head computed tomography scan revealed a well-defined mass with a maximum diameter of 4 cm and a high density in the sella turcica. These findings led to a diagnosis of acromegaly. The patient experienced sudden onset of visual disturbance and headaches on hospital day 6 and underwent emergency surgery under a diagnosis of pituitary apoplexy. There are few reports of patients with diabetic ketoacidosis that are diagnosed with acromegaly. We herein describe this rare case of acromegaly complicated by pituitary apoplexy.
