Hyperadrenalcorticism in a Case of Acromegaly With Insulin-Resistant Diabetes*

DIABETES mellitus was recognized as a feature of acromegaly in the early descriptions of Marie (1). These original observations have been confirmed by many subsequent observers. In the 100 cases described by Cushing and Davidoff (2), glycosuria was present in 25 per cent and clinical diabetes in an additional 12 per cent. A later study of the same 100 cases and 53 additional cases of acromegaly showed the incidence of glycosuria to be 36 per cent and of clinical diabetes, 17 per cent. Thus, the occurrence of diabetes in acromegaly far exceeds that in the general population. Almost without exception the skeletal manifestations of acromegaly precede the onset of diabetes (average time interval 9.2 years) (3). The severity of the disturbance in carbohydrate metabolism varies. In many acromegalics it is demonstrable solely by an abnormal glucose tolerance curve or by mild intermittent glycosuria. Diabetes in acromegalic patients is often mild and controlled by diet and small doses of insulin, which has suggested to some that the diabetes does not differ from pancreatic diabetes (3, 4, 5, 6, 7). However, relative ineffectiveness of insulin has been observed in many cases (2, 8, 9, 10, 11). Even genuine resistance to insulin has occurred. Ulrich (8) reported a patient with acromegaly who developed diabetes while under medical observation. Insulin was necessary for the control of the diabetes, in daily doses as high as 360 units for a short period of time. The insulin requirement rapidly decreased and finally insulin could be entirely withdrawn. Later, following an operation, diabetes reappeared and a dose of 100 units of insulin daily was required for control.