Acta Med. 2026, 69: 32-36
Growth Hormone-Mediated Diabetic Ketoacidosis: A Rare Presentation of Acromegaly
aDepartment of Medicine, Prapokklao Hospital, Chanthaburi province, Thailand
bDepartment of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
cDepartment of Medicine, Somdet Phra Phutthaloetla Hospital, Samut Songkhram province, Thailand
dDepartment of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
eExcellence Centre in Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
Received September 10, 2025
Accepted March 6, 2026
Acromegaly is a chronic disorder caused by pathological hypersecretion of growth hormone (GH), most commonly due to pituitary somatotroph adenomas. Excess GH leads to elevated insulin-like growth factor 1 (IGF-1) levels, which together mediate progressive physical changes and a wide range of systemic complications. A key metabolic abnormality in acromegaly is impaired glucose metabolism, which may result in diabetes through mechanisms of insulin resistance. This report describes a case of diabetic ketoacidosis (DKA), a severe complication of relative insulin deficiency, presenting as a rare initial manifestation of acromegaly. Following surgical intervention and remission of acromegaly, the glycemic control of the patient significantly improved, underscoring the importance of addressing the underlying endocrinopathy. This report highlights the critical need for comprehensive clinical evaluations in patients with common metabolic disorders, such as diabetes mellitus, to identify rare underlying causes and ensure timely diagnosis. Furthermore, it examines potential mechanisms of ketosis in acromegaly and reviews current approaches to glycemic management in this population, where evidence-based guidelines remain limited.
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This is an open-access article distributed under the terms of the Creative Commons Attribution License.
