January - March 2006, Volume 2, Issue 1

Capatina C, Baculescu N, Trifanescu R, Stancu C, Badiu C, Ciubotaru V, Coculescu M

Hyperglycemic hyperosmolar state after transsfenoidal surgery for pituitary adenoma

Acta Endo (Buc) 2006, 2 (1): 79-89
doi: 10.4183/aeb.2006.79

Hyperosmolar hyperglycemic non-ketotic state is a life-threatening emergency manifested by a marked elevation of blood glucose, hyperosmolarity, and little or no ketosis. It most frequently develops in middle-aged or elderly patients, often in the setting of previously mild type 2 diabetes and in the presence of one of the established risk factors (e.g. infection, cerebrovascular accident, myocardial infarction). We present the case of a 48 years old woman with no past history of diabetes who developed hyperosmolar hyperglycemic nonketotic state after transsphenoidal surgery for a large macroprolactinoma. Despite having symptoms (secondary amenorrhoea and galactorrhoea) for many years the patient only had inconsistent medical follow-up and eventually she developed optic chiasm syndrome. She was referred for pituitary surgery performed by transsphenoidal route. After surgery there was marked improvement of the visual signs but few days after intervention the patient presented with polydipsia, polyuria and paresthesiae. Based on laboratory tests that showed a markedly elevated blood glucose level (1088 mg/dl), hyperosmolarity, no acidosis therefore, a diagnosis of hyperglycemic hyperosmolar state was made. With rehydration and insulinotherapy she recovered and the evolution was favourable over weeks with discontinuation of insulin administration. The patient still had high prolactin level after surgery (3060.3 ng/dl) so we also initiated dopamine agonist bromocriptine treatment. In addition to the well known effects of dopamine agonist upon prolactinoma it also has beneficial effects on glycemic control in diabetics (it reduces insulin resistance, both fasting and postprandial plasma glucose levels and HbA1c levels). We discuss the possible explanations of the syndrome and the effects of bromocriptine treatment.

Keywords: prolactinoma, diabetes, hyperosmolar, pituitary surgery, insulin

Correspondence: Mihail Coculescu, ?C. I. Parhon? Institute of Endocrinology, Bd. Aviatorilor 34-36, Bucharest, Romania, fax: +4021.3198718, e-mail: m.coculescu@uni-davila.ro