Growth Hormone-Mediated Diabetic Ketoacidosis: A Rare Presentation of Acromegaly.

Acromegaly is a chronic disorder caused by pathological hypersecretion of growth hormone (GH), most commonly due to pituitary somatotroph adenomas. Excess GH leads to elevated insulin-like growth factor 1 (IGF-1) levels, which together mediate progressive physical changes and a wide range of systemic complications. A key metabolic abnormality in acromegaly is impaired glucose metabolism, which may result in diabetes through mechanisms of insulin resistance. This report describes a case of diabetic ketoacidosis (DKA), a severe complication of relative insulin deficiency, presenting as a rare initial manifestation of acromegaly. Following surgical intervention and remission of acromegaly, the glycemic control of the patient significantly improved, underscoring the importance of addressing the underlying endocrinopathy. This report highlights the critical need for comprehensive clinical evaluations in patients with common metabolic disorders, such as diabetes mellitus, to identify rare underlying causes and ensure timely diagnosis. Furthermore, it examines potential mechanisms of ketosis in acromegaly and reviews current approaches to glycemic management in this population, where evidence-based guidelines remain limited.