Abstract
Although the excessive secretion of GH leads to insulin resistance enhancement, the involvement of a silent somatotroph adenoma in abnormal glucose tolerance has not been elucidated. A 50 - yearold man was admitted with a headache and bitemporal hemianopia caused by a pituitary macroadenoma. He had no physical signs and symptoms of acromegaly nor hypopituitarism, and his baseline serum levels of GH and insulin - like growth factor-1 (IGF-1) were normal. However, a 75 - g oral glucose tolerance test (OGTT) showed unsuppressed GH concentrations as well as plasma glucose levels consistent with diabetes pattern. A transsphenoidal adenomectomy was performed, and we diagnosed the patient as having a silent somatotroph adenoma based on positive GH in the immunohistochemistry. Postoperative OGTT showed GH suppression and a normal pattern of plasma glucose levels after glucose loading. The post-surgery homeostasis model assessment insulin resistance index (HOMA - IR) and the Matsuda Index indicated improved insulin sensitivity in the absence of perioperative body-mass-index change. These observations suggest that reversible abnormal glucose tolerance is associated with a silent somatotroph adenoma in this patient.
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