Case Study:
Patient: Ms. Aliya, a 45-year-old woman, diagnosed with acromegaly five years ago. Despite treatment with a growth hormone receptor antagonist, she continued to experience persistent hyperglycemia and insatiable hunger.
Presentation: Ms. Aliya presented with classic acromegaly features – enlarged hands and feet, prominent facial features, and a deep, booming voice. She also complained of excessive thirst, frequent urination, and uncontrollable cravings for sugary foods. Glycated hemoglobin (HbA1c) remained elevated at 8.5%, despite optimal insulin dosing.
Investigations: Blood tests revealed elevated levels of both insulin and glucagon, suggesting insulin resistance. Further analysis showed significantly elevated amylin levels compared to the reference range. This raised suspicion of amylin’s contribution to Ms. Aliya’s persistent hyperglycemia and appetite dysregulation.
Diagnosis: The combined picture of acromegaly, insulin resistance, elevated glucagon, and high amylin levels led to the diagnosis of amylin-mediated hyperglycemia, a relatively under-recognized complication in acromegaly.
Treatment: In addition to continuing her growth hormone therapy, Ms. Aliya initiated treatment with pramlintide, an amylin analog that mimics its satiety-promoting effects without stimulating glucagon secretion. She also received nutritional counseling to manage her cravings and implement a healthy diet plan.
Outcomes: Within a few weeks of pramlintide initiation, Ms. Aliya reported a significant reduction in her appetite and cravings. Her blood sugar levels started to come down, and her HbA1c gradually declined to 7.2% within three months. Her overall well-being and energy levels improved, and she felt more in control of her hunger.
Discussion: Ms. Aliya’s case highlights the complex interplay between growth hormone, insulin, glucagon, and amylin in acromegaly. It demonstrates the potential for amylin dysregulation to contribute to significant glycemic challenges and highlights the importance of considering amylin levels in managing acromegaly patients with persistent hyperglycemia. The successful use of pramlintide in this case underscores the promising role of amylin-targeting therapies in improving glycemic control and quality of life for these patients.
Future Considerations: Further research is needed to optimize the use of amylin-based therapies in acromegaly, develop novel amylin-targeting medications with improved efficacy and side effect profiles, and explore personalized treatment approaches based on individual amylin response.
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