Abstracts - Case Reports

MANAGEMENT OF DIABETES IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNODEFICIENCY SYNDROME *Manish S. Kushe DiabEndoCare Super Specialty Centre, Margao, Goa, India *E-mail: [email protected] Introduction: The introduction of highly active antiretroviral therapy (HAART) has markedly improved survival in people living with human immunodeficiency virus (HIV). As longevity increases, noncommunicable comorbidities such as diabetes mellitus (DM) are becoming increasingly prevalent. More than 60% of HIV-positive individuals aged ≥50 years have at least one comorbidity, and HIV infection is associated with a higher risk of DM. Antiretroviral therapy-related metabolic dysfunction, mitochondrial toxicity, lipodystrophy, and insulin resistance contribute to DM development. Currently, no specific guidelines exist for managing DM in this population. Case Reports: We describe three male patients with HIV and coexisting DM to highlight varied clinical presentations and management challenges. Case 1: A 38-year-old male with HIV for 15 years and newly diagnosed diabetes presented with chest discomfort and worsening glycemic control. Examination revealed a large, hard right breast lump, later confirmed as malignant on biopsy. Case 2: A 42-year-old male with type 2 diabetes mellitus (T2DM) for 3 years and HIV on HAART for 15 years had obesity and abnormal liver function tests. Despite a normal FIB-4 score (0.74), FibroScan at two centers showed Grade 3 liver fibrosis. Initiation of a glucagon-like peptide-1 receptor agonist led to weight reduction and improved glycemic control. Case 3: A 52-year-old male with long-standing T2DM, hypertension, and HIV had poor glycemic control despite thrice-daily biphasic insulin. Detectable C-peptide suggested preserved endogenous insulin secretion. Insulin was discontinued, and oral hypoglycemic agents including sulfonylureas achieved better control. Discussion: Diabetes in people living with HIV shows heterogeneous presentations and requires individualized assessment. Careful evaluation of metabolic status, residual beta-cell function, and comorbidities can optimize therapy. Dedicated guidelines for diabetes management in this population are urgently needed. A GIANT TWIST BEHIND HYPERGLYCEMIA: ACROMEGALY PRESENTING AS DIABETIC KETOACIDOSIS *Priya Kumari, Preetam N Wasnik, Pranita Das, Prashant G Badole All India Institute of Medical Sciences, Raipur, Chhattisgarh, India *E-mail: [email protected] Introduction: Acromegaly is a rare endocrine disorder caused by excess growth hormone (GH), usually due to a pituitary adenoma, with an estimated prevalence of about 60 per million and an incidence of nearly 0.49 per 100,000 in India. Delayed diagnosis is common because of its insidious onset. Excess GH and insulin-like growth factor-1 (IGF-1) cause insulin resistance, resulting in glucose intolerance or diabetes, while diabetic ketoacidosis as an initial presentation is exceedingly rare. Case Report: A 42-year-old woman with known type 2 diabetes mellitus and hypertension presented with altered sensorium, vomiting, and dehydration. Clinical evaluation and laboratory investigations confirmed diabetic ketoacidosis. After stabilization with intravenous fluids, insulin infusion, and electrolyte correction, further assessment was undertaken due to coarse facial features, acral enlargement, deepened voice, and chronic headache. Hormonal evaluation included hemoglobin A1c (HbA1c), serum cortisol, prolactin, GH, and IGF-1 levels. Radiological evaluation was performed using contrast-enhanced magnetic resonance imaging (MRI) of the pituitary. Surgical management involved endoscopic transsphenoidal excision, followed by histopathological examination and postoperative hormonal monitoring.Investigations showed severe hyperglycemia with HbA1c 11.4%, elevated IGF-1 (474 ng/mL), and high GH levels. MRI revealed a 3-cm pituitary macroadenoma with cavernous sinus extension (Knosp Grade IV). Histopathology confirmed a GH-secreting pituitary adenoma. Postoperatively, the patient developed transient diabetes insipidus, managed conservatively. She achieved stable glycemic control with a marked reduction in GH levels on follow-up. Discussion: This case highlights an extremely rare presentation of acromegaly with diabetic ketoacidosis as the initial manifestation. It underscores the importance of careful clinical examination to identify subtle features such as coarse facial appearance, acral enlargement, and deepened voice. Early recognition and timely transsphenoidal excision of the GH-secreting pituitary adenoma led to a significant reduction in GH levels and marked improvement in glycemic control.