Abstract
The diagnosis of acromegaly is based on demonstration of excess growth hormone (GH) and Insulin-Like Growth Factor-1 (IGF-1) secretion. IGF-1 is the most reliable biochemical indicator of activity of acromegaly. However, there are some pitfalls in the interpretation of change of plasma IGF-1 levels. We aim to report a case with acromegaly that has low IGF-1 levels and elevated GH levels associated with poorly controlled type 2 diabetes mellitus and malnutrition. A 38-years-old woman was admitted to emergency departmant due to hyperglycemia, weakness, cough, dyspnea, high fever. She has been complaining for enlargement of her hands and feet for ten years and she was cachectic for a long time. During oral glucose tolerance test (OGTT), serum growth hormone levels were found to be higher than normal range according to the matching age and sex subjects but IGF-1 and IGFBP-3 levels were measured lower than the reference range. A macroadenoma of 3x2.5 cm diameter was determined in magnetic resonance imaging of the pituitary gland. As a conclusion, determining elevated IGF-1 levels are very important for the diagnosis and activity of acromegaly, but careful interpretation of IGF-1 levels is necessary in type 2 diabetic patients with acromegaly. Key Words: Acromegaly, IGF-1, malnutrition, type 2 diabetes mellitus.
Highlights
The diagnosis of acromegaly is based on demonstration of excess growth hormone (GH) and Insulin-Like Growth Factor-1 (IGF-1) secretion
We aimed to report a case of acromegaly which had normal IGF-1 levels and elevated GH levels associated with poorly controlled type 2 diabetes mellitus and malnutrition
There is a strong correlation between IGF-l levels and residual disease activity [14] and plasma IGF-1 levels are a good predictor of severity of disease
Summary
The diagnosis of acromegaly is based on demonstration of excess growth hormone (GH) and Insulin-Like Growth Factor-1 (IGF-1) secretion. As a conclusion, determining elevated IGF-1 levels are very important for the diagnosis and activity of acromegaly, but careful interpretation of IGF-1 levels is necessary in type 2 diabetic patients with acromegaly. An acromegalic patient with low Insulin-Like Growth Factor-1 levels: it may not be found to be elevated during diagnosis of acromegaly each time. Previous studies reported that elevated growth hormone concentration and inappropriately normal IGF-1 levels may be found in type 2 diabetic acromegalic patient [10]. Both of poorly controlled diabetes mellitus and malnutrition may impact on GH/IGF-1 axis [11,12]
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