A Rare Metabolic Paradox: Diabetic Ketoacidosis Presenting as the Initial Symptom in Undiagnosed Acromegaly

Abstract

Acromegaly is a rare endocrine disorder resulting from the chronic hypersecretion of growth hormone, usually as a result of a pituitary adenoma. While insulin resistance and secondary diabetes mellitus are common metabolic complications of acromegaly, diabetic ketoacidosis is an extremely rare manifestation of the disease. In this report, we present a case of a 28-year-old female patient who presented with vomiting, abdominal pain, and shortness of breath to the emergency department and was found to have severe hyperglycemia and metabolic acidosis consistent with DKA. The patient had the characteristic signs of acromegaly, including an enlarged jaw, macroglossia, coarse facial features, and enlarged hands and feet. The patient’s imaging studies revealed a 2.2x2.9x2.2 cm sellar-suprasellar mass with extension into the cavernous sinus, consistent with a pituitary macroadenoma. The patient was managed with the standard DKA protocol and then referred for endocrine evaluation and management of her acromegaly. This case report highlights the extremely rare occurrence of DKA as a possible cause of undiagnosed and untreated acromegaly and the importance of a thorough clinical evaluation and early diagnosis of endocrine disorders in patients with acute metabolic decompensation syndromes.