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A. Herrero-Ruiz [1; 2] and H. S. Villanueva-Alvarado [1] and J. J. Corrales-Hernández [1; 2; 3] and C. Higueruela-Mínguez [1] and J. Feito-Pérez [4] and J. M. Recio-Cordova [1; 2]

Academic Editor: Lucy Mastrandrea

1, Service of Endocrinology and Nutrition, University Clinical Hospital of Salamanca, Paseo de San Vicente No. 58, 37007 Salamanca, Spain

2, Department of Medicine, University of Salamanca, Campus Miguel de Unamuno, s/n, 37007 Salamanca, Spain, usal.es

3, Cancer Research Institute (IBMCC-CSIC/USAL) and Institute for Biomedical Research, University of Salamanca, Salamanca, Spain, usal.es

4, Service of Anatomic Pathology, University Clinical Hospital of Salamanca, Paseo de San Vicente No. 58, 37007 Salamanca, Spain

Received Jun 29, 2017; Accepted Oct 10, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant syndrome characterized by the combined appearance of tumors in the parathyroid glands, pancreas islet cells, and the anterior pituitary. This type of syndromes is known to be associated with the secretion of a wide range of hormones which are often responsible for alterations in the glucose metabolism. However, the presence of diabetic ketosis and/or ketoacidosis is a rare clinical situation, with very few cases reported so far. Also, and in an even less common case, the patient simultaneously presented a GH-producing pituitary macroadenoma and a meningioma, a combination which is extremely rare.

2. Case Report

We present the clinical case of a 35-year-old woman with a history of Chagas disease who was admitted in the Unit of Endocrinology with hyperglycemia and ketosis in the context of onset of DM with weakness, polydipsia, and polyuria of 4 months of evolution, together with a weight loss of 10 kg over the last 6 months. Also, she presented amenorrhea for 4 months and hyperhidrosis. The examination revealed a slight prognathism, growth of acral parts of the body, and grade 1 goiter with a 2-cm left thyroid nodule.

The analysis showed glucose 248 mg/dL, HbA1c 14.6%, calcium 11.3 mg/dL, phosphorus 2.3 mg/dL, and urine calcium 513 mg/24 h. Given the initial findings, the study was expanded to include a hormone profile test (Table 1), a thyroid ultrasound (28 × 16-mm...

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