Endocrine Abstracts

Case summary: A 69-year-old female, known hypertensive and diabetic, with history of hyperthydroidism, s/p Subtotal Thyroidectomy, s/p TAHBSO secondary to Myoma uteri, consulted for a regular check-up. Patient presented with a fasting blood glucose of 17.7 mmol/L and HBA1C was 11.4%. Pertinent physical findings includes ancanthosis nigrican, bilateral grade II pitting edema, and elevated blood pressure (200/100 mMHg) hence, was advised to be admitted. During the course of admission, the patient had persistent cbg readings of “HI” (>500 pg/mlmg/dl). Insulin requirements increased dramatically as high as 200 units/hour, but despite of high dose insulin, patient remained hyperglycemic and serum insulin level at that time was 4,486 U.i.U/L. Anti-Insulin antibody receptor was requested but was not available in our country. Blood samples were sent to National Institute of Health, Cambridge laboratory for anti-insulin antibody receptor which revealed negative result. A significant finding of elevated Leptin >300 ng/ml, highest ever encounted by NIH was reported. Laboratory work up for autoimmune disease was done, such as serum ANA (anti-nuclear antibody), erythrocyte sedimentation rate, thyroid function test, Kaoling clotting time, Lupus anticoagulant and double stranded DNA sedimentation rate which all revealed negative results. Prednisone at 60 mg/day was started in this patient, with noticeable decreasing insulin requirement and decreasing cbg’s down to <100 mg/dl subsequently. This is a rare case of severe insulin resistance syndrome with severe leptin resistance.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.