1
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Abuzeid O, Heiligenstein M, Noureddine L, Heiselman C, Bernasko J. Acute glycogenic hepatopathy in pregnancy: a case report and literature review. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Acute glycogenic hepatopathy (AGH) is a rare complication of poorly controlled diabetes mellitus. This is the first report in the English literature describing accurate diagnosis and management of AGH during pregnancy.
Case presentation
A 46 year-old gravida 4 para 2 presented at 30 weeks gestation with uncontrolled diabetes, ketoacidosis, and severe hypertension. Euglycemia and normotension were achieved within 24 h of admission but serum transaminase levels which had been normal on admission increased to a very high level over several days, and then resolved spontaneously.
Conclusions
AGH may occur during pregnancy and should be considered in the context of chronic poorly controlled overt diabetes, rapid normalization of maternal blood glucose levels following high dose insulin therapy, and unexplained new-onset serum transaminase levels elevation. Accurate diagnosis is important because the correct treatment is conservative management, not delivery.
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Affiliation(s)
- Omar Abuzeid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Mia Heiligenstein
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Lama Noureddine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - Cassandra Heiselman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
| | - James Bernasko
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine , Renaissance School of Medicine at Stony Brook University , Stony Brook , NY , USA
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2
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Garcês Soares S, Medas R, Conceição F, Silva R, Paiva JA, Carneiro AC. Hepatic Glycogenosis: An Underdiagnosed Entity? Cureus 2022; 14:e23853. [PMID: 35530830 PMCID: PMC9072257 DOI: 10.7759/cureus.23853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Hepatic glycogenosis (HG) is a rare complication of long-standing poorly controlled type 1 diabetes mellitus (T1DM), which is often misdiagnosed as non-alcoholic fatty liver disease (NAFLD). Despite the existence of several reports in the literature, it still is underrecognized, even among gastroenterologists. Differential diagnosis between these entities is essential since they have different prognoses. We report a case of an 18-year-old female, with a medical history of poorly controlled T1DM, admitted to an intensive care unit with severe diabetic ketoacidosis (DKA). Upon admission, aminotransferases were significantly elevated; bilirubin and coagulation tests were normal. Despite adequate DKA treatment, she had persistently elevated aminotransferases and hyperlactacidemia. Imaging studies showed hepatomegaly and bright liver parenchyma. Extensive laboratory workup was negative for other causes of liver disease. So, a liver biopsy was performed, which was consistent with the diagnosis of HG. Under strict metabolic control, she had progressive improvement, achieving biochemical normalization within 6 months. This case highlights the need for clinicians to be aware of this condition due to non-negligible differences between HG and NAFLD, with the latter progressing to fibrosis, and ultimately cirrhosis and hepatocarcinoma. On the opposite, HG is considered a benign condition, associated with an excellent prognosis that can be reversible after adequate metabolic control. Liver biopsy remains the gold standard method for HG diagnosis since it can distinguish it from NAFLD.
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3
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Singh Y, Gurung S, Gogtay M. Glycogen hepatopathy in type-1 diabetes mellitus: A case report. World J Hepatol 2022; 14:471-478. [PMID: 35317186 PMCID: PMC8891674 DOI: 10.4254/wjh.v14.i2.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It has been studied that fluctuating glucose levels may superimpose glycated hemoglobin in determining the risk for diabetes mellitus (DM) complications. While non-alcoholic steatohepatitis (NASH) remains a predominant cause of elevated transaminases in Type 2 DM due to a strong underplay of metabolic syndrome, Type 1 DM can contrastingly affect the liver in a direct, benign, and reversible manner, causing Glycogen hepatopathy (GH) - with a good prognosis.
CASE SUMMARY A 50-year-old female with history of poorly controlled type 1 DM, status post cholecystectomy several years ago, and obesity presented with nausea, vomiting, and abdominal pain. Her vitals at the time of admission were stable. On physical examination, she had diffuse abdominal tenderness. Her finger-stick glucose was 612 mg/dL with elevated ketones and low bicarbonate. Her labs revealed abnormal liver studies: AST 1460 U/L, ALP: 682 U/L, ALP: 569 U/L, total bilirubin: 0.3mg/dL, normal total protein, albumin, and prothrombin time/ international normalized ratio (PT/INR). A magnetic resonance cholangiopancreatography (MRCP) demonstrated mild intra and extra-hepatic biliary ductal dilation without evidence of choledocholithiasis. She subsequently underwent a diagnostic ERCP which showed a moderately dilated CBD, for which a stent was placed. Studies for viral hepatitis, Wilson’s Disease, alpha-1-antitrypsin, and iron panel came back normal. Due to waxing and waning transaminases during the hospital course, a liver biopsy was eventually done, revealing slightly enlarged hepatocytes that were PAS-positive, suggestive of glycogenic hepatopathy. With treatment of hyperglycemia and ensuing strict glycemic control, her transaminases improved, and she was discharged.
CONCLUSION With a negative hepatocellular and cholestatic work-up, our patient likely had GH, a close differential for NASH but a poorly recognized entity. GH, first described in 1930 as a component of Mauriac syndrome, is believed to be due to glucose and insulin levels fluctuation. Dual echo magnetic resonance imaging sequencing and computed tomography scans of the liver are helpful to differentiate GH from NASH. Still, liver biopsy remains the gold standard for diagnosis. Biopsy predominantly shows intra-cellular glycogen deposition, with minimal or no steatosis or inflammation. As GH is reversible with good glycemic control, it should be one of the differentials in patients with brittle diabetes and elevated transaminases. GH, however, can cause a dramatic elevation in transaminases (50-1600 IU/L) alongside hepatomegaly and abdominal pain that would raise concern for acute liver injury leading to exhaustive work-up, as was in our patient above. Fluctuation in transaminases is predominantly seen during hyperglycemic episodes, and proper glycemic control is the mainstay of the treatment.
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Affiliation(s)
- Yuvaraj Singh
- Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
| | - Susant Gurung
- Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
| | - Maya Gogtay
- Internal Medicine, Saint Vincent Hospital, Worcester, MA 01604, United States
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4
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Mertens J, De Block C, Spinhoven M, Driessen A, Francque SM, Kwanten WJ. Hepatopathy Associated With Type 1 Diabetes: Distinguishing Non-alcoholic Fatty Liver Disease From Glycogenic Hepatopathy. Front Pharmacol 2021; 12:768576. [PMID: 34759828 PMCID: PMC8573337 DOI: 10.3389/fphar.2021.768576] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022] Open
Abstract
Autoimmune destruction of pancreatic β-cells results in the permanent loss of insulin production in type 1 diabetes (T1D). The daily necessity to inject exogenous insulin to treat hyperglycemia leads to a relative portal vein insulin deficiency and potentiates hypoglycemia which can induce weight gain, while daily fluctuations of blood sugar levels affect the hepatic glycogen storage and overall metabolic control. These, among others, fundamental characteristics of T1D are associated with the development of two distinct, but in part clinically similar hepatopathies, namely non-alcoholic fatty liver disease (NAFLD) and glycogen hepatopathy (GlyH). Recent studies suggest that NAFLD may be increasingly common in T1D because more people with T1D present with overweight and/or obesity, linked to the metabolic syndrome. GlyH is a rare but underdiagnosed complication hallmarked by extremely brittle metabolic control in, often young, individuals with T1D. Both hepatopathies share clinical similarities, troubling both diagnosis and differentiation. Since NAFLD is increasingly associated with cardiovascular and chronic kidney disease, whereas GlyH is considered self-limiting, awareness and differentiation between both condition is important in clinical care. The exact pathogenesis of both hepatopathies remains obscure, hence licensed pharmaceutical therapy is lacking and general awareness amongst physicians is low. This article aims to review the factors potentially contributing to fatty liver disease or glycogen storage disruption in T1D. It ends with a proposal for clinicians to approach patients with T1D and potential hepatopathy.
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Affiliation(s)
- Jonathan Mertens
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.,Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Maarten Spinhoven
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Ann Driessen
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium.,CORE, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Sven M Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Wilhelmus J Kwanten
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
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5
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Inayat F, Ur Rahman A, Wahab A, Riaz A, Zahid E, Bejarano P, Pimentel R. Gastric Inflammatory Fibroid Polyp: A Rare Cause of Occult Upper Gastrointestinal Bleeding. J Investig Med High Impact Case Rep 2021; 8:2324709620936840. [PMID: 32602395 PMCID: PMC7328486 DOI: 10.1177/2324709620936840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Inflammatory fibroid polyps (IFPs) are rare mesenchymal lesions that can arise
throughout the gastrointestinal tract. These tumors represent less than 0.1% of
all gastric polypoid lesions and are frequently found incidentally on endoscopic
evaluation. While presenting symptoms depend on the location of the tumor,
gastric polyps commonly present with epigastric pain and early satiety. We
hereby delineate the case of a middle-aged female who presented with chronic
iron deficiency anemia and a positive fecal occult blood test. She underwent an
upper endoscopy, which revealed an actively oozing umbilicated lesion in the
gastric antrum. Endoscopic ultrasound divulged the submucosal origin of the
lesion. It was subsequently excised using endoscopic mucosal resection.
Pathologic examination of the resected specimen confirmed the diagnosis of
gastric IFP. Furthermore, we conducted a systematic literature search of the
MEDLINE database centered on gastric IFPs from January 2000 till March 2020. The
data on patient demographics, clinical features, endoscopic findings, lesion
site and size, and treatment approaches were collected and analyzed. This
article illustrates the overarching need for clinicians to be vigilant of
gastric IFPs presenting with initial clinical symptoms suggestive of occult
upper gastrointestinal bleeding. Prompt diagnosis and management of gastric IFPs
carry paramount importance to combat chronic unexplained iron deficiency anemia
following occult bleeding in such patients. A concoction of endoscopy, biopsy,
and immunohistochemical examination can be employed toward their prompt
detection. Although gastric IFPs have conventionally been treated with surgery,
endoscopic resection is now emerging as a safe and efficient therapeutic
modality.
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Affiliation(s)
| | | | - Ahsan Wahab
- Baptist Medical Center South, Montgomery, AL, USA
| | - Amir Riaz
- Cleveland Clinic Florida, Weston, FL, USA
| | - Effa Zahid
- Services Institute of Medical Sciences, Lahore, Pakistan
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6
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Ahmed FW, Kirupakaran T, Quante M, Smith A. Hepatomegaly, Elevated Hepatic Enzymes, and Bridging Fibrosis in Patients With Type 1 Diabetes Mellitus. Cureus 2021; 13:e14446. [PMID: 33996309 PMCID: PMC8114958 DOI: 10.7759/cureus.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Glycogenic hepatopathy is a rare but reversible condition that includes acute liver dysfunction and hepatomegaly. This occurs due to excessive glycogen accumulation in the hepatocytes. It can occur in patients with poorly controlled type 1 diabetes mellitus. We are reporting a case of a 17-year-old girl who developed liver dysfunction following admission with diabetic ketoacidosis. Ultrasound abdomen confirmed hepatomegaly. However, with improvement in her metabolic control, her liver enzymes and hepatomegaly improved.
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Affiliation(s)
- Fahad W Ahmed
- Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation, Brighton, GBR
| | - Tharaga Kirupakaran
- Diabetes and Endocrinology, Brighton and Sussex Medical School, Brighton, GBR
| | - Mara Quante
- Histopathology, University Hospitals Sussex NHS Foundation, Brighton, GBR
| | - Andrew Smith
- Diabetes, Diabetes Care for You and Sussex Community Foundation NHS Trust, Brighton, GBR
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7
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Adams SH, Bernshteyn M, Masood U, Corines J, Manocha D. Glycogenic Hepatopathy Masquerading as Acute Pancreatitis. Cureus 2021; 13:e13397. [PMID: 33758698 PMCID: PMC7978395 DOI: 10.7759/cureus.13397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Glycogenic hepatopathy (GH), defined histologically by hepatocytic glycogen accumulation without fatty change or fibrosis, is a benign reversible condition. It presents clinically as hepatomegaly with elevated liver enzymes in young diabetic (type 1) patients with poor glycemic control. We report a case of a 20-year-old female with a history of poorly controlled type 1 diabetes mellitus (T1DM) and prior pancreatitis who presented with sharp epigastric pain and hepatomegaly. She was found to have diabetic ketoacidosis with elevated lipase and amylase. Though at first her symptoms were erroneously attributed to pancreatitis, a liver biopsy showing glycogenated nuclei led to a diagnosis of GH.
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Affiliation(s)
- Steven H Adams
- Pathology, State University of New York Upstate Medical University, Syracuse, USA
| | - Michelle Bernshteyn
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Umair Masood
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
| | - James Corines
- Pathology, State University of New York Upstate Medical University, Syracuse, USA
| | - Divey Manocha
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
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8
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Yousaf MN, Ehsan H, Ehsan S, Sagheer U, Chaudhary F. Glycogenic Hepatopathy: A Reversible Complication of Uncontrolled Diabetes Mellitus. Cureus 2020; 12:e9323. [PMID: 32850201 PMCID: PMC7444849 DOI: 10.7759/cureus.9323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Glycogenic hepatopathy (GH) is a rare complication of long-standing uncontrolled type I diabetes mellitus (TIDM) resulting in liver dysfunction and hepatomegaly due to intrahepatic deposition of glycogen. Herein we present a 19-year-old male with a history of TIDM and multiple prior hospitalizations with diabetic ketoacidosis (DKA) who presented with nausea, vomiting, right upper quadrant pain, and massive hepatomegaly. Laboratory workup was consistent with DKA and revealed a greater than 10-fold increase in liver enzymes. Despite the resolution of DKA, his liver function was worsening, and further workup was indicated. Ultimately, he underwent a liver biopsy that showed swollen hepatocytes overloaded with intracytoplasmic glycogen consistent with glycogenic hepatopathy. It is an underestimated entity and physicians should have a high index of suspicion for GH in individuals presenting with liver dysfunction, hepatomegaly, and poor glycemic control in TIDM. Strict glycemic control may result in complete resolution of disease.
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Affiliation(s)
- Muhammad N Yousaf
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, USA.,Section of Digestive Diseases, Yale School of Medicine, New Haven, USA
| | - Hamid Ehsan
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Sajid Ehsan
- Internal Medicine, Anne Arundel Medical Center, Annapolis, USA
| | - Usman Sagheer
- Internal Medicine, Medstar Union Memorial Hospital, Baltimore, USA
| | - Fizah Chaudhary
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
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9
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Hepatocellular Glycogen Accumulation in the Setting of Poorly Controlled Type 1 Diabetes Mellitus: Case Report and Review of the Literature. Case Reports Hepatol 2020; 2020:9368348. [PMID: 32128265 PMCID: PMC7048907 DOI: 10.1155/2020/9368348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/22/2020] [Indexed: 02/06/2023] Open
Abstract
Glycogenic hepatopathy (GH) is the accumulation of glycogen in the hepatocytes and represents a rare complication in patients with diabetes mellitus (DM), most commonly type 1 DM. We present a case of a 23-year-old woman with a medical history of poorly controlled type 1 DM and gastroesophageal reflux disease (GERD) who presented with progressively worsening right-sided abdominal pain. Diagnostic workup resulted in a liver biopsy with hepatocytes that stained heavily for glycogen with no evidence of fibrosis or steatohepatitis. A diagnosis of glycogenic hepatopathy was made, and an aggressive glucose control regimen was implemented leading to resolution of symptoms and improvement in AST, ALT, and ALP. In addition to presenting this rare case, we offer a review of literature and draw important distinctions between glycogenic hepatopathy and other differential diagnoses with the aim of assisting providers in the diagnostic workup and treatment of glycogenic hepatopathy.
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10
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Hamed AE, Elwan N, Naguib M, Elwakil R, Esmat G, El Kassas M, Abd-Elsalam S, Moussa S. Diabetes Association with Liver Diseases: An Overview for Clinicians. Endocr Metab Immune Disord Drug Targets 2019; 19:274-280. [PMID: 30444204 DOI: 10.2174/1871530318666181116111945] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a strong association between liver diseases and diabetes (DM) which is higher than expected by a correlation between two very common diseases. Liver diseases may occur as a result of diabetes, and the reverse is true as well. AIM To review the etiology of this association between liver diseases and diabetes and how to diagnose it. METHODS Studies that identified this association between liver diseases and diabetes and how to diagnose it was reviewed. RESULTS This association can be divided into the following categories: liver disease related to diabetes (Diabetic hepatopathy), hepatogenous diabetes (HD), and liver diseases that occur in conjunction with Diabetes mellitus. Two hours after glucose loading is the best screening test for HD. HbA1c may neither be suitable for diagnosis nor monitoring of diabetes that links liver disease. CONCLUSION NAFLD, hepatogenous diabetes, glycogenic hepatopathy and diabetic hepatosclerosis are the most important association between liver diseases and diabetes. The criteria for the diagnosis of diabetes associating liver disease are the same for primary diabetes. Two hours post glucose load is the best screening test for HD due to the fact that fasting glucose can be normal early in the disease. The tool used for diabetes monitoring depends on stage and severity of liver condition.
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Affiliation(s)
| | - Nadia Elwan
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Reda Elwakil
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gamal Esmat
- Faculty of Medicine, Cairo University, Cairo, Egypt
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11
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Abstract
Glycogenic hepatopathy is excessive intrahepatic glycogen accumulation. It is a rare complication of long-standing, poorly controlled type 1 diabetes mellitus. We report a case of a 19-year-old woman with a history of poorly controlled diabetes mellitus and frequent admissions for diabetic ketoacidosis, who presented with abdominal pain, nausea, vomiting, and hepatomegaly. She was found to have diabetic ketoacidosis with persistently elevated serum lactate that did not improve with insulin infusions. She eventually underwent a liver biopsy, which showed excessive intracytoplasmic glycogen accumulation consistent with glycogenic hepatopathy.
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12
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Medhioub M, Ayedi H, Chelbi E, Khsiba A, Hamzaoui L, Azzouz MM. Mauriac syndrome: An unusual presentation with portal fibrosis. Presse Med 2019; 48:718-720. [PMID: 31133337 DOI: 10.1016/j.lpm.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/18/2019] [Accepted: 05/07/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mouna Medhioub
- Mohamed Taher Maamouri Hospital, gastro-enterology department, 8000 Nabeul, Tunisia.
| | - Hend Ayedi
- Mohamed Taher Maamouri Hospital, gastro-enterology department, 8000 Nabeul, Tunisia
| | - Emna Chelbi
- Mohamed Taher Maamouri Hospital, pathology department, 8000 Nabeul, Tunisia
| | - Amal Khsiba
- Mohamed Taher Maamouri Hospital, gastro-enterology department, 8000 Nabeul, Tunisia
| | - Lamine Hamzaoui
- Mohamed Taher Maamouri Hospital, gastro-enterology department, 8000 Nabeul, Tunisia
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13
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Azariadis K, Gatselis NK, Koukoulis GK, Dalekos GN. Glycogenic hepatopathy as a cause of severe deranged liver enzymes in a young patient with type 1 diabetes mellitus. BMJ Case Rep 2019; 12:12/3/e228524. [PMID: 30898943 DOI: 10.1136/bcr-2018-228524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Glycogenic hepatopathy (GH) is a rare complication of poorly controlled type 1 diabetes mellitus (T1DM). We present a 19-year-old woman with T1DM and autoimmune thyroiditis who admitted to our department because of abrupt onset intermittent abdominal pain in the right upper quadrant accompanied by laboratory evidence of acute anicteric hepatitis. Physical examination revealed significant hepatomegaly but the common imagining studies were negative. Following exclusion of common causes of acute hepatitis and because of the presence of smooth muscle antibodies in a young female patient with already established two autoimmune diseases, a liver biopsy was performed in order to exclude the potential presence of autoimmune hepatitis. However, liver histology showed typical findings of GH. Intense treatment targeting strict glycemic control resulted in normalisation of liver biochemistry. This case underlines that GH should be considered as a rare cause of acute hepatitis in T1DM patients with poor glycemic control.
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Affiliation(s)
- Kalliopi Azariadis
- Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece.,Institute of Internal Medicine and Hepatology, Larissa, Greece
| | - George K Koukoulis
- Department of Pathology, University of Thessaly, Medical School, Larissa, Thessaly, Greece
| | - Georgios N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece.,Institute of Internal Medicine and Hepatology, Larissa, Greece
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14
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An Unusual Presentation of Glycogenic Hepatopathy with Bridging Fibrosis. ACG Case Rep J 2018; 5:e31. [PMID: 29721513 PMCID: PMC5917940 DOI: 10.14309/crj.2018.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/28/2018] [Indexed: 12/03/2022] Open
Abstract
Glycogenic hepatopathy is a rare and under-recognized complication of poorly controlled diabetes mellitus. We report a patient who presented with predominant elevation in alkaline phosphatase and liver biopsy showing bridging fibrosis, which is an unusual presentation of glycogenic hepatopathy. This case emphasizes the fact that glycogenic hepatopathy can also present with a cholestatic pattern of liver abnormality and with liver fibrosis, which warrants further study because severe fibrosis can progress to cirrhosis.
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15
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Sherigar JM, Castro JD, Yin YM, Guss D, Mohanty SR. Glycogenic hepatopathy: A narrative review. World J Hepatol 2018; 10:172-185. [PMID: 29527255 PMCID: PMC5838438 DOI: 10.4254/wjh.v10.i2.172] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Abstract
Glycogenic hepatopathy (GH) is a rare complication of the poorly controlled diabetes mellitus characterized by the transient liver dysfunction with elevated liver enzymes and associated hepatomegaly caused by the reversible accumulation of excess glycogen in the hepatocytes. It is predominantly seen in patients with longstanding type 1 diabetes mellitus and rarely reported in association with type 2 diabetes mellitus. Although it was first observed in the pediatric population, since then, it has been reported in adolescents and adults with or without ketoacidosis. The association of GH with hyperglycemia in diabetes has not been well established. One of the essential elements in the pathophysiology of development of GH is the wide fluctuation in both glucose and insulin levels. GH and non-alcoholic fatty liver disease (NAFLD) are clinically indistinguishable, and latter is more prevalent in diabetic patients and can progress to advanced liver disease and cirrhosis. Gradient dual-echo MRI can distinguish GH from NAFLD; however, GH can reliably be diagnosed only by liver biopsy. Adequate glycemic control can result in complete remission of clinical, laboratory and histological abnormalities. There has been a recent report of varying degree of liver fibrosis identified in patients with GH. Future studies are required to understand the biochemical defects underlying GH, noninvasive, rapid diagnostic tests for GH, and to assess the consequence of the fibrosis identified as severe fibrosis may progress to cirrhosis. Awareness of this entity in the medical community including specialists is low. Here we briefly reviewed the English literature on pathogenesis involved, recent progress in the evaluation, differential diagnosis, and management.
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Affiliation(s)
- Jagannath M Sherigar
- Department of Gastroenterology and Hepatology, NYP-Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States
| | - Joline De Castro
- Department of Gastroenterology and Hepatology, NYP-Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States
| | - Yong Mei Yin
- NYP-Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States
| | - Debra Guss
- Department of Gastroenterology and Hepatology, NYP-Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States
| | - Smruti R Mohanty
- Department of Gastroenterology and Hepatology, NYP-Brooklyn Methodist Hospital, Brooklyn, NY 11215, United States
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16
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Focal Hepatic Glycogenosis in a Patient With Uncontrolled Diabetes Mellitus Type 1. J Comput Assist Tomogr 2017; 42:230-235. [PMID: 28937487 DOI: 10.1097/rct.0000000000000673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hepatomegaly and elevated liver enzymes in patients with diabetes are commonly associated with fatty liver disease. However, physicians often forget about another intrinsic substance that can cause a similar clinical picture-glycogen. Liver stores approximately one third of the total body glycogen and is responsible for blood glucose homeostasis. Excessive hepatocellular glycogen accumulation occurs not only in congenital glycogen storage diseases, but also in acquired conditions associated with hyperglycemic-hyperinsulinemic states such as uncontrolled diabetes mellitus, high-dose corticosteroid use, and dumping syndrome. All reported cases of acquired abnormal glycogen deposition described a diffuse form of hepatic glycogenosis with the entire liver involved in the accumulating process. To our knowledge, this is the first reported case of abnormal focal glycogen deposition in a patient with diabetes mellitus type 1 with imaging and pathologic correlation. Awareness of the imaging appearance of focal glycogen deposition can help to distinguish it from other pathologic conditions.
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