MON-701 A case which GLP 1 receptor agonist semaglutide enabled the management of both obesity and diabetes mellitus, suggesting the potential for diabetes remission

Abstract

Disclosure: S. Hashimoto: None.Case presentation: Male, A 36-year-old man with diabetes mellitus and obesity presented to our department of endocrinology with poor glycemic control for six years and uncontrolled overweight. Medical history: From 26 years of age, he became obese with a BMI of about 30. At 29 years of age, he was diagnosed with bitemporal hemianopsia at a certain hospital, and a few months later, he visited the neurosurgery department of the same hospital with headaches and was given diagnosis of a non-functioning pituitary tumor, suspected pituitary apoplexy, associate with hypopituitarism, and diabetes (HbA1c 8.2%). Trans-sphenoidal surgery for pituitary tumor was performed, and the histopathological diagnosis was xantho-granuloma. After surgery, he was administered hydrocortisone 15 mg/day, levothyroxine 75 μg/day replacement therapy, diabetic SGLT2 inhibitors, DPP4 inhibitors, metformin, and pioglitazone, but his BMI worsened to 31.6 and his obesity worsened, and his HbA1c worsened to 12.0%. At age of 34, he was referred to our department. GH secretion was severely insufficient with a peak value of 0.18ng/mL in the GHRP2 test, and in the LH-RH test, both pre- and peak values ​​of LH were less than 0.10mIU/mL, FSH peak value was 0.54mIU/mL, and blood testosterone was below the sensitivity level. Calorie restriction and rhGH administration were started to correct obesity (no desire for hypogonadal treatment), and DPP4 inhibitors were discontinued and switched to dulaglutide 0.75mg, but the effect was insufficient with HbA1c in the 8% range and BMI 30.9. After switching to semaglutide and gradually increasing the dose from 0.25 mg/week to 1.0 mg/week, after 6 months Hb1c decreased to 6.0% and BMI to 27.6, and after 12 months HbA1c decreased to 5.5% and BMI to 26.2. A 75g oral glucose tolerance test showed normalized fasting blood glucose levels of 64 m/dL and 2-hour values ​​of 117 mg/dL. Conclusion: This patient with hypopituitarism accompanied by obesity and diabetes had been treated with hormone replacement therapy and conventional oral diabetes medication, however blood glucose and weight were difficult to manage. We reported a case which the long-acting GLP1 receptor agonist semaglutide enabled the management of both obesity and diabetes mellitus, suggesting the potential for diabetes remission. The administration of GLP-1 receptor agonist provides patients with greater for weight and glycemic management, especially in cases which management is difficult with conventional treatment.Presentation: Monday, July 14, 2025