摘要
目的 探讨以糖尿病酮症酸中毒（DKA）起病的肢端肥大症患者的临床特点.方法 报告2017年2月北京协和医院收治的1例垂体生长激素/泌乳素混合瘤合并DKA患者的诊治经过,并复习文献中该类罕见疾病的病例特点.结果 患者以DKA合并高渗状态起病,生长激素（GH）及泌乳素（PRL）均明显升高,影像学检查示鞍区巨大占位.最大胰岛素使用量达到90 U/d（0.8 U·kg-1·d-1）,血糖控制不佳.溴隐亭治疗后GH、PRL下降均〉50%,胰岛素减量至12 U（0.1 U·kg-1·d-1）,血糖控制平稳.文献复习提示：肢端肥大症患者中DM发生率15%~38%,以DKA为首发症状发生率约1%,其主要机制为胰岛素抵抗和脂肪分解,控制血糖需要胰岛素50~360 U/d,垂体瘤手术或生长抑素治疗后胰岛素用量减少.结论 DKA为肢端肥大症罕见临床表现,患者存在明显胰岛素抵抗,控制血糖除胰岛素外尚需控制原发疾病.
Objective To explore the clinical characteristics of acromegaly patients who had diabetic ketoacidosis （DKA） as their main manifestation. Methods To report the diagnosis and treatment of a patient with pituitary growth hormone and prolactin mixed tumor complicated with DKA from Peking Union Medical College Hospital in February 2017, and the characteristics of these patients in literature were reviewed. Results The patient had DKA and high osmotic status as his first manifestation. His growth hormone （GH） and prolactin （PRL） levels were significantly increased, and imaging results identified a large pituitary mass. The plasma glucose level was high even with insulin treatment at a dose of 90 U/d （0.8 U ＆#183; kg-1 ＆#183; d-1）. GH and PRL decreased for more than 50% after bromocriptine treatment. The dose of insulin was reduced to 12 U/d （0.1 U ＆#183; kg-1 ＆#183; d-1）, and the blood glucose was controlled. In literature, the prevalence of impaired glucose tolerance and diabetes mellitus was 15%-38%. DKA as the initial clinical condition occurs in 1% acromegaly patients. The main mechanisms are insulin resistance and lipolysis. Plasma glucose level could be controlled with a dose of insulin treatment （50-360 U/d）. The dose could be reduced after pituitary adenoma resection and/or somatostatin therapy. Conclusion DKA is a rare clinical manifestation of acromegaly. These patients have severe insulin resistance. To control high plasma glucose levels needs insulin treatment as well as the control of primary disease.
出处
《中华糖尿病杂志》
CAS
CSCD
2017年第5期316-321,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
