We report one case of acromegaly with diabetes mellitus, which was first diagnosed by diabetic ketoacidosis accompanied by acute pancreatitis.
The patient was a 32-year-old man. The presumptive age of onset of acromegaly was 25. In October 1982, he had abdominal pain and clouding of consciousness. Therefore, he was admitted to the emergency hospital. He was diagnosed as diabetic ketoacidosis. We suspected he had acute pancreatitis because the serum and urinary amylase were very high. Continuous intravenous insulin injection was started, and the maximum total daily insulin dose was 178 U. Subsequently, the control of blood glucose and his general condition were improved. The serum amylase diminished rapidly. The amylase creatinine clearance rate, lipase and elastase-I were still at a high level, but diminished slowly. Therefore, we suspected acute pancreatitis from the aspects of pancreatic function and morphologic examination. He was prescribed CB-154. In February 1983, he was treated by Hardy's operation and radiation. After the surgery and radiation therapy, the basal line of growth hormone and control of blood glucose were improved.
Secondary diabetes mellitus due to acromegaly is generally severe and insulin-resistant. Therefore, it is prone to diabetic ketoacidosis by infection or operation.