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A case of poorly controlled insulin-dependent diabetes led to liver glycogen deposition and abnormal liver enzymes. That, from researchers at the 68th Annual Scientific Meeting of the American College of Gastroenterology Seth D. Hoffman, MD, and colleagues, Loyola University Medical Center, Maywood, Illinois, United States, discussed the case of a 22-year-old woman who presented to the emergency department with a 1 month history of increasing abdominal girth, right upper quadrant pain and a 13.5 kg weight gain. She had been diagnosed with insulin-dependent diabetes 13 months previously and hospitalised with diabetic ketoacidosis five times in 1 year.
Physical examination revealed anasarca and a mildly tender liver palpable 7 to 8 cm below her midcostal margin. Laboratory tests demonstrated high serum glutamic oxaloacetic transaminase (AST) and glutamic pyruvic transaminase (ALT), and normal alkaline phosphatase and bilirubin levels.
Computed tomographic scan of the liver revealed an enlarged liver, and liver biopsy was performed. Biopsy showed findings consistent with the presence of glycogen and indicated diffuse glycogenosis.
The patient’s liver enzymes, oedema and abdominal pain markedly improved after 7 days of tight glycaemic control.
Dr. Hoffman said that in cases of abnormal liver enzymes without hepatitis, other causes must be ruled out and a normal workup carried out to identify abnormal liver function.
He thinks the present case of liver glycogenosis is uncommon, though 8 to 10 cases have been reported in patients of all ages with poorly controlled diabetes. He believes that when tight glycaemic control was initiated, the glycogen deposits were mobilised by insulin.
"Get the diabetes under control," he said, "and the problem resolves."
Dr. Hoffman recommends considering the diagnosis of liver glycogenosis whenever a poorly controlled diabetes patient has liver enzyme abnormalities.
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