Reversible severe glycogenic hepatopathy in type 1 diabetes

Summary Case presentation We report a case of severe glycogenic hepatopathy in a 17-year-old boy with poorly controlled type 1 diabetes. On presentation, major findings included unexplained pronounced hepatomegaly and increased liver enzymes, ferritin, and triglycerides. Histology and electron microscopy evaluation showed severe glycogen storage, steatosis, and signs of fibrosis, resembling the histomorphological findings of Mauriac syndrome. After information about the nature of the disease and intensification of insulin therapy with insulin pump, liver enzymes, ferritin, and triglycerides normalized within 1 month. Conclusion Glycogenic hepatopathy is a rare but important potential complication in poorly controlled juvenile diabetic patients. With improved metabolic control, it is fully reversible.

Relationship of Juvenile Diabetic Retinopathy with Thyropathies, Lipid Exchange and Melatonin Production

Progression of diabetic retinopathy is associated with a large number of risk factors, and hyperlipidemia is one of the most common. The work is focused on peculiarities of the progression of juvenile diabetic retinopathy (JDR), depending on the presence of concomitant distyroidism in patients with juvenile diabetes mellitus (JDM), the state of lipid metabolism and melatonin production. The aim. To determine the features of the JDR progression depending on the type of concomitant dysthyroidism, the state of lipid metabolism and production of the hormone melatonin. Materials and methods. The examination of three groups of patients was carried out: group 1 (152 patients) included patients in whom JDM proceeded without thyropathy; group 2 (99 patients) included patients with JDM in combination with autoimmune thyroiditis (AIT); group 3 (111 patients) included patients in whom JDM was accompanied by an increased level of thyroid-stimulating hormone (TSH). Results. It was found that the frequency of proliferative diabetic retinopathy (PDR) in the group with JCD and elevated TSH (21.6%) was 2.7 times higher than the frequency of PDR in the group with JDM and AIT (8.1%) and 3.7 times exceeded the frequency of PDD in JDM without distyroidism (5.9%). The greatest violations of all links of lipid metabolism were found in patients with JDM with an increased level of TSH, which contributes to a more pronounced progression of JDR than in patients without thyropathy or concomitant AIT. The average daily excretion of the hormone melatonin (M) among the studied groups was the lowest in patients with PDD with JCD in combination with increased TSH (38.4 ± 2.7 nmol/day) compared with patients with PDD with JCD without thyropathy (48.3 ± 3.8 nmol/day; p <0.01) and with AIT (42.5 ± 5.6 nmol/day; p <0.01), and compared with the control indicator (52.7 ± 5.8 nmol/day; p <0.001). Conclusions. Based on the results obtained it can be concluded that the combination of type 1 JDM with elevated TSH is accompanied by significant disorders of lipid metabolism and melatonin production and this is a risk factor for accelerated progression of JDR. Keywords: juvenile diabetic retinopathy, thyropathy, melatonin production, lipid metabolism.