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      Case of diabetic ketoacidosis as an initial presentation of Cushing’s syndrome

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      Author(s): 1 , 2 , 3 , 4 , 5 ,
      Publication date (Electronic):
      Journal: Endocrinology, Diabetes & Metabolism Case Reports
      Publisher: Bioscientifica Ltd

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          Abstract

          Summary

          Diabetic ketoacidosis (DKA) is commonly encountered in clinical practice. The current case is a unique and rare presentation of DKA as the initial manifestation of Cushing’s disease secondary to ACTH-secreting pituitary adenoma. Appropriate management as elaborated in the article led to total remission of diabetes as well as the Cushing’s disease.

          Learning points:

          • DKA is a serious and potentially life-threatening metabolic complication of diabetes mellitus.

          • Some well-known precipitants of DKA include new-onset T1DM, insulin withdrawal and acute illness.

          • In a patient presenting with DKA, the presence of a mixed acid–base disorder warrants further evaluation for precipitants of DKA.

          • We present a rare case of DKA as an initial manifestation of Cushing’s disease secondary to ACTH-producing pituitary adenoma.

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          Recurrent Diabetic Ketoacidosis in Inner-City Minority Patients

          Lori Randall, Jovan Begovic, Megan Hudson … (2011)
          OBJECTIVE To conduct a bedside study to determine the factors driving insulin noncompliance in inner-city patients with recurrent diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS We analyzed socioeconomic and psychological factors in 164 adult patients with DKA who were admitted to Grady Hospital between July 2007 and August 2010, including demographics, diabetes treatment, education, and mental illness. The Patient Health Questionnaire-9 and the Short Form-36 surveys were used to screen for depression and assess quality of life. RESULTS The average number of admissions was 4.5 ± 7 per patient. A total of 73 patients presented with first-time DKA, and 91 presented with recurrent DKA; 96% of patients were African American. Insulin discontinuation was the leading precipitating cause in 68% of patients; other causes were new-onset diabetes (10%), infection (15%), medical illness (4%), and undetermined causes (3%). Among those who stopped insulin, 32% gave no reasons for stopping, 27% reported lack of money to buy insulin, 19% felt sick, 15% were away from their supply, and 5% were stretching insulin. Compared with first-time DKA, those with recurrent episodes had longer duration of diabetes (P < 0.001), were a younger age at the onset of diabetes (P = 0.04), and had higher rates of depression (P = 0.04), alcohol (P = 0.047) and drug (P < 0.001) abuse, and homelessness (P = 0.005). There were no differences in quality-of-life scores, major psychiatric illnesses, or employment between groups. CONCLUSIONS Poor adherence to insulin therapy is the leading cause of recurrent DKA in inner-city patients. Several behavioral, socioeconomic, psychosocial, and educational factors contribute to poor compliance. The recognition of such factors and the institution of culturally appropriate interventions and education programs might reduce DKA recurrence in minority populations.
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            Infection as a Trigger of Diabetic Ketoacidosis in Intensive Care--Unit Patients

            J-R Le Gall, P Vexiau, B. Schlemmer … (2001)
            We determined the prevalence and indicators of infection in intensive care unit (ICU) patients with diabetic ketoacidosis (DKA) by performing a retrospective analysis of 123 episodes of DKA (in 113 patients) managed in a medical ICU between 1990 and 1997. In univariate analysis, features associated with infection were female sex, neurological symptoms at admission, fever during the week before admission, a need for colloids, a high blood lactate level at admission, and lack of complete clearance of ketonuria within 12 h. Multivariate analysis identified 3 independent predictors of infection: female sex (odds ratio [OR], 2.31; confidence interval [CI], 1.05-5.35), neurological symptoms at admission (OR, 2.83; CI, 1.18-6.8), and lack of complete clearance of ketonuria within 12 h (OR, 3.73; CI, 1.58-9.09). Infection is the leading trigger of DKA in ICU patients. Neurological symptoms at admission and lack of complete clearance of ketonuria within 12 h are useful warning signals of infection.
            Article 0 comments Cited 7 times – based on 0 reviews     Review now
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              Fulminant diabetes mellitus associated with pregnancy: case reports and literature review.

              Takeshi Inagaki, Yutaka Nishii, Naomi Suzuki … (2002)
              We report two cases of type 1 diabetes mellitus fulminantly developed as diabetic ketoacidosis (DKA) at 19 weeks of gestation and immediately after delivery. Development of type 1 diabetes around pregnancy is not rare, but its fulminant development is highly uncommon. We also review the relevant literature concerning mostly Japanese cases. In our cases, the group of patients with fulminant progressive diabetes mellitus associated with pregnancy required insulin replacement therapy even after the acute period and showed high value of pancreatic exocrine enzymes, i.e. amylase, elastase, and lipase. The phenotype of this group was similar to "nonautoimmune, fulminant type 1 diabetes" described by Imagawa et al., where the laboratory data of type 1 diabetes-related autoantibodies showed negative. It is well known that autoimmune diseases are in good control during pregnancy. Our present finding suggests that this type of fulminant type 1 diabetes mellitus associated with pregnancy might develop as a consequence of a nonautoimmune mechanism.
              Article 0 comments Cited 4 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 23 February 2017
                Publication date Collection: 2017
                Volume: 2017
                Electronic Location Identifier: 16-0123
                Affiliations
                [1 ]University of Pittsburgh Medical Center-Endocrinology , Diabetes and Metabolism Fellowship Program, Pittsburgh, Pennsylvania, USA
                [2 ]Veteran Affairs Medical Center and Broadlawns Medical Center , Des Moines University of Osteopathic Medicine, Des Moines, Iowa, USA
                [3 ]University of Iowa , Carver College of Medicine, Iowa City, Iowa, USA
                [4 ]Medicine and Endocrinology , University of Iowa, Iowa City, Iowa, USA
                [5 ]Des Moines University , Des Moines, Iowa, USA
                Author notes
                Correspondence should be addressed to U M Kabadi; Email: ukabadi@ 123456gmail.com
                Article
                Publisher ID: EDM160123
                DOI: 10.1530/EDM-16-0123
                PMC ID: 5404467
                SO-VID: 34c2cb08-0d0b-44df-9807-979c76ffc1be
                Copyright © © 2017 The authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                Date received : 2 December 2016
                Date accepted : 26 January 2017
                Categories
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease

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