Endocrine Abstracts

Background: We report this interesting case of worsening diabetes and diabetes ketoacidosis in a young male with acromegaly who was commenced on Pasireotide treatment.

Case Report: This 30 years gentleman was diagnosed with Acromegaly in April 2015. He underwent trans- sphenoidal surgery in January 2016 with significant residual tumour post-surgery. His IGF1 remained elevated and was unresponsive to Lanreotide. He was commenced on adjuvant therapy with Pasireotide, in early 2017 under the Novartis clinical trial. He was also found to have partial hypopituitarism, and required hydrocortisone and testosterone replacement. He was found to have elevated HbA1c- 55 mmol/mol in April 2016. He was initiated on Metformin and Sitagliptin treatment along with lifestyle and dietary advice. Two months after commencement of Pasereotide, he was admitted with an episode of severe diabetic ketoacidosis (DKA) with no other obvious precipitant. His HbA1c at the time was 75 mmol/mol. Basal bolus regime of insulin was commenced along with Metformin. His HbA1c improved over time with insulin treatment and regular diabetes team input.

Conclusion: Pasereotide is a novel multi-receptor-targeted somatostatin receptor ligand used in therapy for acromegaly. It has been associated with hyperglycemia and DKA in patient with Acromegaly and Cushing’s disease. The hyperglycemia is attributed to reduced insulin secretion and incretin response. This case highlights the need for closer monitoring of HbA1c and glycaemic control in patients with acromegaly and diabetes, and more so for those on Pasireotide therapy.