Context of Uncontrolled Type II Diabetes Mellitus : A Part from the Book Chapter : Case Report and Literature Review on Glycogen Hepatopathy

A 44-year-old male truck driver presents to ED with right upper quadrant pain in the context of uncontrolled type II diabetes mellitus for the last two years. He denies any weight loss, change in appetite, or any changes in bowel motions. He has a past medication history of obstructive sleep apnoea and was unable to comply with CPAP due to the night shift. His regular medications include SR Metformin 2g daily, Empagliflozin 25 mg daily, Insulin Lantus variable dose ranging between 50 and 70 units and Atorvastatin 20 mg. He has smoked 20 cigarettes a day for the last 20 years and drinks a bottle of wine when he is not working.

On examination in the ED, he is haemodynamic stable, febrile and has no signs of chronic liver disease. Chest examination is consistent with chronic obstructive airway disease, and he is noted to have an ejection systolic murmur over the aorta, that radiates to the carotid with a normal second aortic sound. Abdominal examination reveals tender hepatomegaly with a liver span of 25 cm and a smooth and regular surface. No bruit or rubs are noted. Examination of the legs are consistent with length-dependent sensory neuropathy. Examination of the fundus shows early diabetic retinopathy in the form of microaneurysm, but no cotton wool exudate or new vascularization. The macula are normal in both eyes.

Author(s) Details:

Adel Ekladious
Acute Medical Unit, Canberra Hospital, ACT Health, Australia, University of Western Australia, Australia and Australian National University, Australia.


Also See : Methemoglobinemia is Confirmed by Venous : A Part from The Book : Short Note: Neonatal Emergencies


Recent Global Research Developments in Diagnostic Challenges in Glycogenic Hepatopathy: A Review

Glycogenic hepatopathy (GH) is a rare complication of poorly controlled diabetes mellitus. It is characterized by transient liver dysfunction with elevated liver enzymes and associated hepatomegaly due to reversible accumulation of excess glycogen in hepatocytes. Although initially observed in pediatric populations, it has since been reported in adolescents and adults with or without ketoacidosis[1] . The association of GH with hyperglycemia in diabetes is not yet well established. Overlapping clinical and radiographical features often necessitate liver biopsy for definitive diagnosis. Recommended treatment involves stable “tight” glycemic control, and pancreatic transplantation has resulted in sustained GH remission in some cases[2,3] .

For further reading, you can explore the following research articles:

  1. “Clinical Challenges and Images in GI”: An unusual cause of elevated liver enzymes in a diabetic patient [1].
  2. “Glycogenic hepatopathy: A narrative review”: Provides an overview of GH, its pathophysiology, and noninvasive evaluation [2].
  3. “The Liver and Glycogen: In Sickness and in Health”: Discusses pathological manifestations and molecular mechanisms of liver diseases associated with abnormal glycogen accumulation.
  4. “Glycogenic Hepatopathy in Type 1 Diabetes: An Underrecognized Condition”: Focuses on the diagnostic criteria for GH in type 1 diabetes [3].

References

  1. Al-Judaibi, B., Bain, V. G., & Sis, B. (2013). An unusual cause of elevated liver enzymes in a diabetic patient. Gastroenterology, 144(7), 1354.
  2. Sherigar, J. M., De Castro, J., Yin, Y. M., Guss, D., & Mohanty, S. R. (2018). Glycogenic hepatopathy: a narrative review. World journal of hepatology, 10(2), 172.
  3. Imtiaz, K. E., Healy, C., Sharif, S., Drake, I., Awan, F., Riley, J., & Karlson, F. (2013). Glycogenic hepatopathy in type 1 diabetes: an underrecognized condition. Diabetes care, 36(1), e6-e7.

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