Getahun Binyam Melese, Gebeyehu Medhanet Azene, Getahun Amsalu Molla, Kassie Yoseph Gebremedhin
Eka Kotebe General Hospital, Addis Ababa, Ethiopia.
Debre Tabor University, Debre Tabor, Ethiopia.
J Med Case Rep. 2024 Aug 1;18(1):349. doi: 10.1186/s13256-024-04642-9.
Hypoglycemia is a common occurrence in diabetic patients. But unlike non diabetic patients, its causes are frequently related to drugs they are receiving to control blood glucose. But this may not always be the case. Here we report a type 2 diabetic patient with severe hypoglycemia owing to acute hypopituitarism secondary to pituitary apoplexy.
A 45 year old male diabetic patient from Ethiopia taking 2 mg of oral glimepiride daily who presented with change in mentation of 30 minutes and blood glucose recording of 38 mg/dl upon arrival to the emergency room. Brain magnetic resonance imaging showed pituitary macroadenoma with hemorrhage suggestive of pituitary apoplexy. Blood work up showed low adrenocorticotropic hormone, cortisol, and serum sodium levels. Subsequently transsphenoidal hypophysectomy was done.
The occurrence of hypoglycemia in a diabetic patient taking sulphonylurea monotherapy is common. But when it is severe enough to cause altered mentation, patients should be approached differently. In the presence of clinical clues suggesting cortisol deficiency, hypopituitarism can be a possible cause.
低血糖在糖尿病患者中很常见。但与非糖尿病患者不同，其病因常与他们用于控制血糖的药物有关。但情况并非总是如此。在此，我们报告一例2型糖尿病患者，因垂体卒中继发急性垂体功能减退而发生严重低血糖。
一名来自埃塞俄比亚的45岁男性糖尿病患者，每天服用2毫克口服格列美脲，因意识改变30分钟，到达急诊室时血糖记录为38毫克/分升。脑部磁共振成像显示垂体大腺瘤伴出血，提示垂体卒中。血液检查显示促肾上腺皮质激素、皮质醇和血清钠水平降低。随后进行了经蝶窦垂体切除术。
服用磺脲类单药治疗的糖尿病患者发生低血糖很常见。但当严重到足以导致意识改变时，应对患者采取不同的处理方法。在存在提示皮质醇缺乏的临床线索时，垂体功能减退可能是一个原因。
