Diabetes in acromegaly is usually noninsulin dependent and is secondar
y to insulin resistance caused by growth hormone excess. Diabetic keto
acidosis is a result of relative insulin deficiency and is a rare feat
ure of acromegaly. We describe a case of acromegaly presenting with di
abetic ketoacidosis. We demonstrate that growth hormone excess can cau
se diabetic ketoacidosis in the presence of relative, but not absolute
insulin deficiency.