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Colegio de Medicina Interna de México.

2012, Number 6

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Med Int Mex 2012; 28 (6)

Acromegaly and insulin resistance. Case Report

Mejía CJJ, Peralta CJA, Sánchez PV, Palacios REP

Language: Spanish
References: 20
Page: 612-617
PDF size: 181.93 Kb.


ABSTRACT

Objective: Case report of acromegaly associated with insulin resistance.
Case report: Woman with diabetes mellitus (DM) type 2 diagnosed at 55 years and acromegaly at 60 years of age. Her laboratory studies confirmed IGF-1 levels of 690nmol / L (75-212 nmol / L RIA), GH (Growth Hormone) 98.5ng/ml baseline (QL) in hyperglycemia and nuclear magnetic resonance (NMR) with pituitary macroadenoma. Transcranial neurosurgical treatment received twice. Persisted in the postoperative period with active acromegaly and pituitary tumor remnant. She was admitted several times to the endocrinology unit because persisted with uncontrolled blood glucose. She kept regular adherence to diet and pharmacological treatment. In April 2012 was admitted to the hospital for treatment adjustment; and total insulin requirements with the averages of the reported glucometrics in the day one were with 92 UI and capillary glucose 260 mg/dL, day two with 126 UI and capillary glucose 187 mg/dL, day three 144 UI and capillary glucose 210 mg/dL; day four 142 UI and capillary glucose 165 mg/dL, and day five 134 UI and average blood glucose levels 145 mg/dL, documenting 2.27 U/kg/día insulin requirements. She improved her glucose levels by associating a sensitizer to the intensive insulin scheme.
Comment: severe insulin resistance is defined by elevated insulin requirements in order to achieve glycemic control targets and reduce or delay chronic complications of diabetes, reduce mortality and improve quality of life. Importantly, several scenarios that can coexist in the diabetic glycemic control and difficult challenges arise in the doctor's treatment decisions.



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