2017 Volume 60 Issue 12 Pages 813-819
The patient was a 32-year-old woman who had experienced amenorrhea since 20XX-5. She noticed her shoe size becoming larger in 20XX-3. She was diagnosed with diabetes mellitus in October 20XX-1 and was treated with insulin therapy, but the therapy was stopped in June 20XX. Physical weariness, excessive thirst, polydipsia, polyuria, manifested in mid-June with body weight loss (10 kg); she presented to our hospital in late June. Her blood glucose level was 362 mg/dL and she showed metabolic acidosis with a high anion gap (pH 7.29, PaCO2 30.4 mmHg, HCO3- 15.0 mmol/L, anion gap 18 mEq/L), as well as a urinary ketone body concentration of 3+. Her FT3 and FT4 levels were 2.04 ng/dL and 4.92 pg/mL, respectively. She was diagnosed with diabetic ketoacidosis and thyrotoxicosis. She experienced headache, which continued from the time of admission, and a sudden visual disturbance manifested on hospital day 4. Magnetic resonance imaging (MRI) of the pituitary revealed a mass in the sella turcica, with hemorrhage. She had high levels of growth hormone (3.20 ng/mL) and insulin-like growth factor-1 (373 ng/mL). These findings led to a diagnosis of acromegaly with pituitary apoplexy. She underwent surgery on the 9th day of hospitalization.
