A case of acromegaly with diabetic retinopathy that improved after trans-sphenoidal pituitary adenomectomy.
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A 52-year-old man with acromegaly developed overt diabetes mellitus at age of 40. He felt an increase in the size of his hands when he was 20. One year prior to admission, he was told that he had proliferative retinopathy. He had photocoagulation and anterior retinal cryocautery treatment of the left eye, but this did not have the desired effect. He was admitted because of congestive heart failure. He had albuminuria. His blood pressure was 170/112 mmHg. Visual acuity was-0.02 on the left. The patient required 15 units of NPH insulin daily and had a fasting serum glucose level of 120μg/dl. There was no CPR response to glucose or L-arginine. He had elevated baseline serum GH levels (230-300 ng/ml), which failed to be suppressed during the oral glucose tolerance test. L-arginine had no effect on GH levels. An IV injection of 500μg of TRH or 100 ig of LH-RH elicited GH relese. After trans-sphenoidal pituitary adenomectomy, his basal GH levels fell to 2.3-7.0 ng/ml and neithera TRH nor I, H-RH had any effect on GH levels. The patient's insulin requirement decreased to 6 units daily. This operative treatment diminished macular edema and led to the absorption of vitreous bleeding. Visual acuity improved to 0. 2-0.3 on the left, although his serum creatinine level rose.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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