Kubo Haremaru, Sugimoto Kazuhiro, Wada Ryota, Sekikawa Naohiro, Inoue Minoru
Diabetes Center, Ohta Nishinouchi Hospital, Koriyama, JPN.
Diabetes, Endocrinology, and Metabolism, Kitasato University School of Medicine, Sagamihara, JPN.
Cureus. 2024 Apr 17;16(4):e58461. doi: 10.7759/cureus.58461. eCollection 2024 Apr.
Acromegaly is a rare disorder characterized by excessive production of growth hormone (GH) from a pituitary tumor, typically leading to elevated glucose levels due to increased insulin resistance; hypoglycemia is rare. However, the long-term effect of excess GH on the peripheral organs is still unclear. Here we present a 69-year-old man evaluated for the cause of a hypoglycemic episode. He was underweight (body mass index: 17.3 kg/m) with sarcopenia, which potentially contributed to his hypoglycemia. Notably, he exhibited progressed proliferative diabetic retinopathy compared to other microvascular complications, leading to further endocrinological investigation. As a result, he was diagnosed with acromegaly showing elevated GH and insulin-like growth factor-1 (IGF-1) with a pituitary tumor. Opting against transsphenoidal surgery (TSS), the patient was treated with a somatostatin analog (SSA), achieving normalized IGF-1 levels with a monthly 120 mg lanreotide injection. In this case, acromegaly could lead to sarcopenia from GH-derived gluconeogenesis in the peripheral organs such as the reduction of muscle leading to reduced glucose reserves. Acromegaly in the elderly may present atypicality. Clinicians should be vigilant for unique manifestations such as advanced diabetic retinopathy, even in elderly patients with hypoglycemia.
肢端肥大症是一种罕见的疾病，其特征是垂体肿瘤过度分泌生长激素（GH），通常由于胰岛素抵抗增加导致血糖水平升高；低血糖很少见。然而，过量GH对周围器官的长期影响仍不清楚。在此，我们报告一名69岁男性，因低血糖发作的病因接受评估。他体重过轻（体重指数：17.3kg/m）且有肌肉减少症，这可能是导致他低血糖的原因。值得注意的是，与其他微血管并发症相比，他表现出进展性增殖性糖尿病视网膜病变，这促使进一步进行内分泌学检查。结果，他被诊断为肢端肥大症，伴有垂体肿瘤，生长激素和胰岛素样生长因子-1（IGF-1）水平升高。由于患者选择不接受经蝶窦手术（TSS），因此接受了生长抑素类似物（SSA）治疗，通过每月注射120mg兰瑞肽使IGF-1水平恢复正常。在这种情况下，肢端肥大症可能会因外周器官（如肌肉减少导致葡萄糖储备减少）中GH衍生的糖异生作用而导致肌肉减少症。老年肢端肥大症可能表现出非典型性。临床医生即使在患有低血糖的老年患者中，也应警惕诸如晚期糖尿病视网膜病变等独特表现。
