Diabetic Ketoacidosis as the First Manifestation of Acromegaly

Diabetic ketoacidosis (DKA) is a rare initial presentation of acromegaly, a condition characterized by chronic growth hormone (GH) excess and insulin resistance. We report the case of a 26-year-old female who presented with new-onset diabetes and severe DKA requiring high insulin doses. Clinical examination revealed features of GH excess, including prognathism, macroglossia, and acral enlargement. Laboratory evaluation confirmed elevated insulin-like growth factor 1 levels and non-suppressed GH following oral glucose tolerance testing. Magnetic resonance imaging revealed a pituitary macroadenoma. A diagnosis of acromegaly secondary to a GH-secreting pituitary adenoma was established. Following transsphenoidal surgery, GH levels declined, and insulin requirements significantly decreased. This case underscores the importance of evaluating secondary causes of diabetes in atypical presentations of DKA, especially in non-obese patients requiring unusually high insulin doses.