Type 2 Diabetes Revealing a Mixed GH (Acromegaly) and Prolactin Adenoma: A Case Report of the Internal Medicine Department of the Gabriel Touré University Hospital, Bamako, Mali

Abstract

Introduction: Pituitary adenomas are benign, well-differentiated tumours that usually grow slowly over several years and are developed monoclonally from anteropituitary endocrine cells. We report a case of mixed GH and prolactin adenoma diagnosed in the Internal Medicine Department of the Gabriel Touré University Hospital, Bamako, Mali. Observation: The patient was a 36-year-old man with a 4-year history of type 2 diabetes mellitus who had consulted a specialist for headache, polyuro-polydipsic syndrome, decreased libido and erectile dysfunction. On clinical examination, a tumour syndrome was noted with headache and visual blur. The biology revealed a GH hypersecretion syndrome (IGF1) which was elevated to 561.9 µg/ml (VN=116-353) and prolactin elevated to 463.3 µIU/ml (VN: 24-324) and diabetes. Pituitary MRI revealed a pituitary macroadenoma. Our patient was treated with Dostinex 0.5mg/week with a gradual increase in dose and insulin. He was also referred to neurosurgery, where he is awaiting removal of the adenoma after glycaemic control and hormone normalisation. The evolution was marked by the disappearance of headaches, improvement in vision, GH and prolactin hypersecretion syndrome and glycaemic control. Conclusion: In sub-Saharan Africa, the problems posed by pituitary adenomatous pathologies are complex, due to the limited biological and morphological investigation facilities and the rarity of specialised surgical facilities.