Endocrine Abstracts

Introduction: Patients with psychotic or depressive disorders have an increased risk of developing metabolic syndrome, not only because of their unhealthy lifestyle (sedentary habits, inadequate diet and smoking) but also because of the negative impact of antipsychotic agents (specially clozapine and olanzapine) on several metabolic features. These include overweight/obesity, dyslipidemia, development of new-onset type 2 diabetes, worsening of pre-existing diabetes and diabetic ketoacidosis.

Case report: 38-year-old man, with bipolar disorder, obesity (BMI 39 kg/m²), dyslipidemia and a positive family history of type 2 diabetes. The patient had been taking quetiapine and lithium for the last years, with good tolerance. In 2013, due to an exacerbation of his psychiatric disorder, his psychiatrist prescribed olanzapine. Two weeks later, he developed polyuria, polydipsia and weight loss, which progressed to nausea and vomiting. He was admitted to our institution with the diagnosis of diabetic ketoacidosis, without any clinically evident precipitating event. Serum C-peptide level was 2.02 ng/ml and HbA1c 13.7%; islet cells and glutamic acid decarboxylase auto-antibodies were not measured. After stabilization, he was discharged, on metformin and a basal-bolus insulin regimen, and referenced to our Outpatient Clinic. When he was reevaluated, already without olanzapine, it was possible to decrease total daily dosage of insulin. Months later, insulin therapy was stopped and now he is on metformin 1500 mg/day and sitagliptin 50 mg/day, with a good metabolic control.

Discussion: The characteristics of the patient and his HbA1c suggests he had an undiagnosed type 2 diabetes, which manifested as a diabetic ketoacidosis. The temporal relationship between the introduction of olanzapine and the development of diabetic ketoacidosis suggests a causality relationship.

Conclusion: This case report illustrates one serious complication of the antipsychotic agents and stresses the importance of an evaluation of the metabolic risk and an individualized selection of the antipsychotic agent on these patients.