Insulin resistance associated to high levels of tumor necrosis factor (TNF) during pituitary apoplexy induced by a pituitary stimulating test in an acromegalic patient

We present a 27-year-old male nondiabetic acromegalic patient who suffered pituitary apoplexy after a sequential pituitary stimulating test (TRH/GnRH) . He was treated with dexamethasone, 16 mg/day, which was progressively red uced from the third day reaching 0.5 mg/day on the 11th day after apoplexy. On the sixth day after the acute episode, he developed hyperglycemia with polyuria and polydipsia requiring up to 940 units a day of regular human in sulin by continuous venous infusion on the ninth day after the apoplexy. At this time, the patient was receiving low dose of dexamethasone. Insulin re quirements then progressively decreased, and 14 days after the acute event blood sugar levels were normal without insulin. In the face of severe insulin resistance during low dose of dexamethasone t herapy, other face tors causing insulin resistance were considered: anti-in sulin antibodies and circulating cytokine tumor necrosis factor (TNF) level s. There was a good correlation between TNF levels and blood glucose. We di scuss the possible influence of high levels of TNF in the pathogenesis of i nsulin resistance.