Diabetic Ketoacidosis Associated With Adrenocorticotropic Hormone-Producing Pituitary Adenoma

Background: To report a case of Chusing's disease in a 51-year-old Japanese woman with diabetic ketoacidosis (DKA). The clinical, laboratory, imaging and histological data of the case are presented, followed by a discussion of the related literature.Case Report: A 51-year-old Japanese woman was admitted to our hospital because of DKA. After treatment of the DKA, endocrinological examinations were performed because of persistent low serum potassium and hypertension. Plasma levels of adrenocorticotropic hormone and cortisol were elevated without a circadian rhythm. Urinary excretion of cortisol was also increased. There was suppression of cortisol in the overnight 8 mg dexamethasone suppression test. Magnetic resonance imaging of the pituitary gland demonstrated a microadenoma. The clinical and laboratory findings of the present case fulfilled the diagnostic criteria for Cushing's disease, and trans-sphenoidal surgery (TSS) was subsequently performed. After surgery, the diabetes mellitus improved without any medication.Conclusions: The DKA and diabetes in our patient may have been related to the Cushing's disease. Although there are few cases of overt Cushing's syndrome or preclinical Cushing's syndrome accompanied by DKA, it should be kept in mind that patients with Cushing's disease and diabetes mellitus may develop DKA following the ingestion of sugar-containing soft drinks.