Advanced proliferative diabetic retinopathy and macular edema in acromegaly: a case report and literature review.
Acromegaly
Growth hormone
Insulin-like growth factor 1
Proliferative diabetic retinopathy
Vascular endothelial growth factor
Journal
Diabetology international
ISSN: 2190-1678
Titre abrégé: Diabetol Int
Pays: Japan
ID NLM: 101553224
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
07
10
2021
accepted:
13
01
2022
entrez:
13
6
2022
pubmed:
14
6
2022
medline:
14
6
2022
Statut:
epublish
Résumé
We describe the multimodal management of a patient with proliferative diabetic retinopathy and diabetic macular edema associated with active acromegaly. A 61-year-old Japanese female who had had type 2 diabetic mellitus for > 10 years complained of deteriorated eyesight. She had distinct acromegalic features, and her visual acuity was 0.05 (right) and 0.4 (left) because of sub-capsular cataracts and proliferative diabetic retinopathy with macular edema. Anti-vascular endothelial growth factor treatments, cataract surgeries and retinal direct laser photocoagulation were performed together with gradual glycemic control with basal insulin to prevent worsening of the visual impairment. She was given an injection of a long-acting somatostatin analog (octreotide LAR) and began taking three bolus mealtime insulin shots with basal insulin beginning 1 month before undergoing a trans-sphenoidal adenomectomy. After this successful surgery, her blood glucose levels immediately decreased, and the rapid-acting insulin at mealtimes was discontinued with the observation of normal growth hormone and insulin-like growth factor (IGF)-1 levels, suggesting that her acromegaly was in remission. Her visual acuity improved without a worsening of diabetic retinopathy. Since the increased IGF-1 production in systemic circulation and local vitreous fluids may be one of the aggravating factors for diabetic retinopathy, our patient's acromegaly complicated with severe retinopathy presented an opportunity for multimodal management in close collaboration with an ophthalmologist, neurosurgeon, and endocrinologist. Our literature review revealed that the estimated prevalence of diabetic retinopathy in cases of acromegaly associated with diabetes mellitus is 12.5-42.9%.
Identifiants
pubmed: 35693995
doi: 10.1007/s13340-022-00571-4
pii: 571
pmc: PMC9174379
doi:
Types de publication
Case Reports
Langues
eng
Pagination
575-579Informations de copyright
© The Japan Diabetes Society 2022.
Déclaration de conflit d'intérêts
Conflict of interestNone of the authors have any potential conflicts of interest associated with this research.
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