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Hepatomegaly and elevated aminotransferases in a patient with poorly regulated diabetes

Elevated liver function, right upper quadrant abdominal pain, and hepatomegaly occurring in a diabetic patient treated with high doses of insulin may point to the presence of pathologyc glycogen accumulation in the liver parenchymal cells. The condition was first described in children, however, studies performed in adults have shown aondition that is similar in many aspects. A case is presented of a 41-year.old female diabetic patient with abnormal liver tests and hepatomegaly. Abdominal ultrasound confirmed liver enlargement without any signs of fatty liver. Liver biopsy revealed a picture compatible with glycogenosis. As excessive hepatic glycogen deposition occurred at an adult age and without a related family history, while the patient presented with normal mental and motor development, the diagnoses of Mauriac syndrome and hereditary were ruled out. The condition was attributed to insulin hyperdosage. The patient was recommended improved glycemic control, more appropriate diet and physical exercise. On follow-up visit 3 months of discharge from the hospital, significant hepatomegaly regression was demonstrated by palpation and ultrasonography, and was accompanied by normalization of serum aminotransferases, blood glucose and glycosalated hemoglobin. Elevated serum aminotransferases and alkaline phosphatase with hepatomegaly as a onsequence of hepatocellular glycogen accumulation can occur in diabetic patients of any age who are treated with high doses of insulin, and should therefore be included in the differential diagnosis.

Hepatomegaly-etiology; Glycogen storage.etiology; Insulin-adverseeffects; Diabetes mellitus; insulin-dependent-complications; Case report

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