Insulin Requirements in Untreated Acromegaly: From 200 to 0

We describe a patient with acromegaly presenting in diabetic ketoacidosis who was able to achieve euglycemia despite discontinuation of all antihyperglycemic therapy prior to surgical or medical treatment for his acromegaly. No previous cases of acromegaly presenting in diabetic ketoacidosis have reported glycemic normalization without antihyperglycemic therapy prior to acromegaly treatment. Our case highlights this unique outcome and postulates that pancreatic β-cell resiliency may be influential on insulin resistance since our patient achieved euglycemia despite a persistent state of excess growth hormone and insulin-like growth factor-1. Our case further emphasizes that consideration for acromegaly should be given in patients presenting with severe insulin resistance and pertinent medical history and physical examination features, and it emphasizes the dramatic range of insulin requirements in patients with acromegaly.