A Patient with Primary Biliary Cirrhosis Complicated with Slowly Progressive Insulin-dependent Diabetes Mellitus
We report a case of primary biliary cirrhosis (PBC) complicated by slowly progressive insulin-dependent diabetes mellitus (SPIDDM). A 67-year-old woman was diagnosed as having PBC based on clinical manifestations and a positive result of anti-mitochondrial antibody. Furthermore, SPIDDM was diagnosed...
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| Published in: | Internal Medicine Vol. 42; no. 6; pp. 496 - 499 |
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The Japanese Society of Internal Medicine
01-06-2003
Japanese Society of Internal Medicine |
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| Abstract | We report a case of primary biliary cirrhosis (PBC) complicated by slowly progressive insulin-dependent diabetes mellitus (SPIDDM). A 67-year-old woman was diagnosed as having PBC based on clinical manifestations and a positive result of anti-mitochondrial antibody. Furthermore, SPIDDM was diagnosed by her clinical course and a positive result of anti-glutamic acid decarboxylase antibody. Both PBC and SPIDDM are considered to be autoimmune diseases. However, the coexistence of PBC and SPIDDM is extremely rare. Liver cirrhosis sometimes accompanies hyperglycemia. When the etiology of liver cirrhosis is an autoimmune disorder such as PBC, SPIDDM should be considered as a cause of hyperglycemia. (Internal Medicine 42: 496-499, 2003) |
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| AbstractList | We report a case of primary biliary cirrhosis (PBC) complicated by slowly progressive insulin-dependent diabetes mellitus (SPIDDM). A 67-year-old woman was diagnosed as having PBC based on clinical manifestations and a positive result of anti-mitochondrial antibody. Furthermore, SPIDDM was diagnosed by her clinical course and a positive result of anti-glutamic acid decarboxylase antibody. Both PBC and SPIDDM are considered to be autoimmune diseases. However, the coexistence of PBC and SPIDDM is extremely rare. Liver cirrhosis sometimes accompanies hyperglycemia. When the etiology of liver cirrhosis is an autoimmune disorder such as PBC, SPIDDM should be considered as a cause of hyperglycemia. (Internal Medicine 42: 496-499, 2003) We report a case of primary biliary cirrhosis (PBC) complicated by slowly progressive insulin-dependent diabetes mellitus (SPIDDM). A 67-year-old woman was diagnosed as having PBC based on clinical manifestations and a positive result of anti-mitochondrial antibody. Furthermore, SPIDDM was diagnosed by her clinical course and a positive result of anti-glutamic acid decarboxylase antibody. Both PBC and SPIDDM are considered to be autoimmune diseases. However, the coexistence of PBC and SPIDDM is extremely rare. Liver cirrhosis sometimes accompanies hyperglycemia. When the etiology of liver cirrhosis is an autoimmune disorder such as PBC, SPIDDM should be considered as a cause of hyperglycemia. |
| Author | YAMASHIRO, Masaaki ARAKAWA, Yukihiro KAMIYAMA, Sakiko YAMASHIRO, Masato KINJO, Fukunori TOMA, Shiyu KAMIYAMA, Tsukasa HOKAMA, Akira CHINEN, Kiyoharu SAKUGAWA, Hiroshi SAITO, Atsushi NAKASONE, Hiroki KINJO, Kazushi MIYAGI, Masatake MATSUSHITA, Tatsuhiko MAKISHI, Tomoko MlYAZATO, Hitoshi OHSHIRO, Takeharu |
| Author_xml | – sequence: 1 fullname: NAKASONE, Hiroki organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 2 fullname: KINJO, Kazushi organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 3 fullname: YAMASHIRO, Masaaki organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 4 fullname: KAMIYAMA, Tsukasa organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 5 fullname: KAMIYAMA, Sakiko organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 6 fullname: MlYAZATO, Hitoshi organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 7 fullname: MATSUSHITA, Tatsuhiko organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 8 fullname: ARAKAWA, Yukihiro organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 9 fullname: OHSHIRO, Takeharu organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 10 fullname: TOMA, Shiyu organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 11 fullname: CHINEN, Kiyoharu organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 12 fullname: YAMASHIRO, Masato organization: The Okinawa Kenritsu Hokubu Hospital – sequence: 13 fullname: MIYAGI, Masatake organization: The Okinawa Kenritsu Chubu Hospital – sequence: 14 fullname: MAKISHI, Tomoko organization: The First Department of Internal Medicine, University of the Ryukyus – sequence: 15 fullname: HOKAMA, Akira organization: The First Department of Internal Medicine, University of the Ryukyus – sequence: 16 fullname: SAKUGAWA, Hiroshi organization: The First Department of Internal Medicine, University of the Ryukyus – sequence: 17 fullname: KINJO, Fukunori organization: The First Department of Internal Medicine, University of the Ryukyus – sequence: 18 fullname: SAITO, Atsushi organization: The First Department of Internal Medicine, University of the Ryukyus |
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| Keywords | Endocrinopathy Case study Human Diabetes mellitus Digestive diseases Hepatic disease Complication Biliary cirrhosis Diagnosis Biliary tract disease cirrhosis |
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| References | 10) Saitoh T, Akamine N, Sakai T, Serizawa S, Tohno H, Horie T. Slowly progressive insulin-dependent diabetes mellitus in an elderly with Graves' Disease. Intern Med 39: 943-946, 2000. 14) Hiraoka A, Kojima N, Yamauchi Y, et al. An autopsy case of primary biliary cirrhosis with severe interstitial pneumonia. Intern Med 40: 1104-1108, 2001. 9) Kobayashi T. Slowly progressive IDDM. Nippon Rinsho 57: 607-611, 1999 (in Japanese, Abstract in English). 18) Kobayashi T. Subtype of insulin-dependent diabetes mellitus (IDDM) in Japan: slowly progressive IDDM-the clinical characteristics and pathogenesis of the syndrome. Diabetes Res Clin Pract 24 Suppl: S95-S99, 1994. 19) Yamada G, Hyodo I, Tobe K, et al. Ultrastructual immunochemical analysis of lymphocytes infiltrating bile duct epithelia in primary biliary cirrhosis. Hepatology 6: 385-391, 1986. 1) Sherlock S, Dooley J. Primary biliary cirrhosis, in: Diseases of the Liver and Biliary System. 10th ed. Sherlock S, Dooley J. Eds. Blackwell Science, Oxford, 1997: 239-252. 3) Elta GH, Sepersky RA, Goldberg MJ, Connors CM, Miller KB, Kaplan MM. Increased incidence of hypothyroidism in primary biliary cirrhosis. Dig Dis Sci 28: 971-975, 1983. 8) Verge CF, Gianani R, Kawasaki E, et al. Prediction of type I diabetes in first-degree relatives using a combination of insulin, GAD, and ICA512bdc/IA-2 autoantibodies. Diabetes 45: 926-933, 1996. 13) Pietropaolo M, Peakman M, Pietropaolo SL, at al. Combined analysis of GAD65 and ICA512 (IA-2) autoantibodies in organ and non-organspecific autoimmune diseases confers high specificity for insulindependent diabetes mellitus. J Autoimmun 11: 1-10, 1998. 16) Rai GS, Hamlyn AN, Dahl MG, Morley AR, Wilkinson R. Primary biliary cirrhosis, cutaneous capillaritis, and IgM associated membranous glomerulonephritis. Br Med J 1: 817, 1977. 15) Lever E, Balasubramanian K, Condon S, Wat BY. Primary biliary cirrhosis associated with ulcerative colitis. Am J Gastroenterol 88: 945-947, 1993. 2) Hall S, Axelsen PH, Larson DE, Bunch TW. Systemic lupus erythematosus developing in patients with primary biliary cirrhosis. Ann Intern Med 100: 388-389, 1984. 17) Nakasone H, Sakugawa H, Fukuchi J, at al. A patient with primary biliary cirrhosis associated with autoimmune hemolytic anemia. J Gastoenterol 35: 245-249, 2000. 5) Kruszynska YT, Home PD, Mclntyre N. Relationship between insulin sensitivity, insulin secretion and glucose tolerance in cirrhosis. Hepatology 14: 103-111, 1991. 6) Chitturi S, Abeygunasekera S, Farrell GC, et al. NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology 35: 373-379, 2002. 7) Albert! KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15: 539-553, 1998. 4) Golding PL, Bown R, Mason AM, Taylor E. "Sicca complex" in liver disease. Br Med I 4: 340-342, 1970. 20) Kobayashi T, Maruyama T, Shimada A, et al. Insulin intervention to preserve beta cell in slowly progressive insulin-dependent (type 1) diabetes mellitus. Ann N Y Acad Sci 958: 117-130, 2002. 11) Yoshida H, Inoue T, Hakamata Y, et al. Slowly progressive IDDM with rheumatoid arthritis and Hashimoto disease in high elderly. Nippon Ronen Igakkai Zasshi 35: 571-576, 1998 (in Japanese, Abstract in English). 12) Betterle C, Zanette F, Pedini B, et al. Clinical and subclinical organspecific autoimmune manifestations in type 1 (insulin-dependent) diabetic patients and their first-degree relatives. Diabetologia 26: 431-436, 1984. |
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| SubjectTerms | Aged Biological and medical sciences Blood Chemical Analysis Blood Glucose - analysis cirrhosis Combined Modality Therapy diabetes mellitus Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 1 - therapy diagnosis Diet Disease Progression Female Gastroenterology. Liver. Pancreas. Abdomen Humans Insulin - therapeutic use Japan Liver Cirrhosis, Biliary - complications Liver Cirrhosis, Biliary - diagnosis Liver Cirrhosis, Biliary - therapy Liver Function Tests Liver. Biliary tract. Portal circulation. Exocrine pancreas Medical sciences Other diseases. Semiology Prognosis Risk Assessment Severity of Illness Index Tomography, X-Ray Computed Treatment Outcome |
| Title | A Patient with Primary Biliary Cirrhosis Complicated with Slowly Progressive Insulin-dependent Diabetes Mellitus |
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