A diabetic patient with empty sella syndrome accompanied by stimulated guanidinoacetic acid metabolism

Since urinary guanidinoacetic acid (GAA) derives from the kidneys, its detection is suggested to be associated with renal disease . We have been making a practice of investigating renal GAA production in diabetic patients, using a citrulline/creatine loading test . We noted a marked in crease in urinary GAA excretion in 1 patient . Since GAA-synthesis is hormonally regulated, we made a through investigation of endocrine function in this patient . She was a 58-year -old woman with a 15-year history of diabetes mellitus, proliferative diabetic retinopathy, and negative microalbuminuria . There was a high plasma GH level and urinary 17-KS analysis revealed an increase in the adrenal androgen-derived fractions . Based on the X -ray finding of ballooning of the sella turcica and the MRI data, empty sella syndrome was diagnosed. It was suggested that stimulated anabolic horm one release had accelerated renal nitrogen metabolism and induced aggravation of he r retinopathy . The findings in this patient implied the involvement of hormones in the development of diabetic complications .