J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://jem.elmerpub.com

Case Report

Volume 000, Number 000, January 2026, pages 000-000

Coexistence of Familial Acromegaly and Genetic Diabetes Mellitus Linked to Mitochondrial Dysfunction

Figure 1. Characteristic clinical signs of acromegaly in the patient. (a) Enlarged nose and lips. (b) Enlarged and coarse wrist (blue arrow) compared to a normal wrist (red arrow). (c) Macroglossia. (d) Enlarged thyroid gland.

Figure 2. MRI of the brain showing tumor process in the sella turcica with signs of pituitary macroadenoma (sagittal plane). The arrow indicates the tumor mass. MRI: magnetic resonance imaging.

Figure 3. X-ray image of the hand, showing hypertrophy of the terminal tufts of the distal phalanges, forming projections similar to spurs (black arrowhead), as well as enlargement of the bases of those phalanges (red arrowhead) and thickened soft tissues (black arrow).

**Table 1.** Basic Investigations
Lab test	Value	Reference range
TSH: thyroid-stimulating hormone; FT4: free thyroxine; FT3: free triiodothyronine; Tg: thyroglobulin; TPO: thyroid peroxidase; Ab: antibody; LH: luteinizing hormone; FSH: follicle-stimulating hormone; ACTH: adrenocorticotropic hormone; GH: growth hormone; PTH: parathyroid hormone; IGF-1: insulin-like growth factor 1.
Hemoglobin g/L	149.0	140 - 180
Fasting glucose mmol/L	5.9	2.8 - 6.1
Glycated hemoglobin %	6.97	4.5 - 6.3
Serum potassium mmol/L	4.7	3.5 - 5.6
Serum sodium mmol/L	137.0	136 - 151
Serum chlorine mmol/L	97.0	96 - 110
Total calcium mmol/L	2.48	2.12 - 2.62
Ionized calcium mmol/L	1.28	1.10 - 1.35
Phosphorus mmol/L	1.3	0.77 - 1.46
Urea mmol/L	5.7	2.6 - 7.2
Creatinine µmol/L	79.0	44 - 96
PTH pg/mL	20.5	15 - 68.3
TSH mU/L	0.465	0.34 - 5.6
FT4 pmol/L	11.08	7.86 - 14.41
FT3 pmol/L	5.67	3.8 - 6.0
Prolactin mU/L	141.11	70 - 565
LH IU/L	4.48	1.24 - 8.62
FSH mIU/mL	11.21	1.27 - 19.26
Testosterone ng/mL	2.97	1.75 - 7.81
Cortisol (8 h) nmol/L	216.84	154 - 624
Cortisol (23 h) nmol/L	74.06
ACTH pg/mL	50.7	5 - 47
GH ng/mL	10.0 ↑	0.05 - 3
IGF-1 µg/L	658.3 ↑	83 - 233
Anti Tg Ab IU/mL	< 0.5	0 - 4
Anti TPO Ab IU/mL	< 0.2	0 - 9

Table 1. Basic Investigations

Lab test

Value

Reference range

TSH: thyroid-stimulating hormone; FT4: free thyroxine; FT3: free triiodothyronine; Tg: thyroglobulin; TPO: thyroid peroxidase; Ab: antibody; LH: luteinizing hormone; FSH: follicle-stimulating hormone; ACTH: adrenocorticotropic hormone; GH: growth hormone; PTH: parathyroid hormone; IGF-1: insulin-like growth factor 1.

Hemoglobin g/L

149.0

140 - 180

Fasting glucose mmol/L

5.9

2.8 - 6.1

Glycated hemoglobin %

6.97

4.5 - 6.3

Serum potassium mmol/L

4.7

3.5 - 5.6

Serum sodium mmol/L

137.0

136 - 151

Serum chlorine mmol/L

97.0

96 - 110

Total calcium mmol/L

2.48

2.12 - 2.62

Ionized calcium mmol/L

1.28

1.10 - 1.35

Phosphorus mmol/L

1.3

0.77 - 1.46

Urea mmol/L

5.7

2.6 - 7.2

Creatinine µmol/L

79.0

44 - 96

PTH pg/mL

20.5

15 - 68.3

TSH mU/L

0.465

0.34 - 5.6

FT4 pmol/L

11.08

7.86 - 14.41

FT3 pmol/L

5.67

3.8 - 6.0

Prolactin mU/L

141.11

70 - 565

LH IU/L

4.48

1.24 - 8.62

FSH mIU/mL

11.21

1.27 - 19.26

Testosterone ng/mL

2.97

1.75 - 7.81

Cortisol (8 h) nmol/L

216.84

154 - 624

Cortisol (23 h) nmol/L

74.06

ACTH pg/mL

50.7

5 - 47

GH ng/mL

10.0 ↑

0.05 - 3

IGF-1 µg/L

658.3 ↑

83 - 233

Anti Tg Ab IU/mL

< 0.5

0 - 4

Anti TPO Ab IU/mL

< 0.2

0 - 9

**Table 2.** Oral Glucose Tolerance Test With a Simultanious Assessment of Growth Hormone Levels, Showing Persistent Carbohydrate Disorders and Remission of Acromegaly
Lab test	Value	Reference range
Glucose mmol/L 0 min	6.06
Glucose mmol/L 60 min	12.24
Glucose mmol/L 120 min	8.27
Glucose mmol/L 180 min	5.74
Growth hormone ng/mL 0 min	0.337	0.05 - 3
Growth hormone ng/mL 60 min	0.302
Growth hormone ng/mL 120 min	0.28
Growth hormone ng/mL 180 min	0.268

Table 2. Oral Glucose Tolerance Test With a Simultanious Assessment of Growth Hormone Levels, Showing Persistent Carbohydrate Disorders and Remission of Acromegaly

Lab test

Value

Reference range

Glucose mmol/L 0 min

6.06

Glucose mmol/L 60 min

12.24

Glucose mmol/L 120 min

8.27

Glucose mmol/L 180 min

5.74

Growth hormone ng/mL 0 min

0.337

0.05 - 3

Growth hormone ng/mL 60 min

0.302

Growth hormone ng/mL 120 min

0.28

Growth hormone ng/mL 180 min

0.268