Endocrine Abstracts

A 54 year-old businesswoman who has been diabetic for 6 years and had a history of PUD. She was referred following complaints of increasing hyperpigmentation of her palms, feet and old scars. She also had a boil on her back, significant weight loss, poor appetite and a slight non-productive cough.

She was transfused with two pints of blood a month earlier at a private hospital when her PCV was found low. She is not hypertensive. Her drug history included metformin, glimepiride, rabeprazole, antacid and hematinics.

On examination, she was obese (BMI 33.8 kg/m²), pale, afebrile, anicteric and had no pedal oedema. Her pulse rate was 80 beats/min, regular and of normal volume and the blood pressure was normal. Apart from the hyperpigmentation of her palms and feet, other systems were normal. Her HbA1c 8%, eGFR was 36.1 ml/min, Serum Vitamin B12 was 109.4 pg·ml (211–946), Blood count showed pancytopenia – Hb 6 g/dl, MCV 97.8 fL, MCH 2.6 pg, MCHC 33.3 g/dl, WBC 3.34×10^9/l, RBC 1.84×10^9/l, Platelets 137x10^9/l. Her bone marrow study showed megaloblastic changes in the marrow and peripheral film. A chest radiograph showed no lesion. HIV1 & 2 serology were negative. Her TFT, ACTH and cortisol were normal. Investigations to exclude pernicious anaemia and celiac disease could not be done for financial reasons.

She was treated as a case of vitamin B12 deficiency anaemia probably metformin-induced with intramuscular hydroxycobalamin 1000 μg weekly for 6 weeks, then monthly for 6 months. She presently takes daily oral B12 and is healthy. Her repeat laboratory workup showed HbA1c 6%, Hb 11.2 g/dl, normal MCV and MCH, WBC, RBC and platelet counts. Serum B12 302.8 pg/ml and eGFR of 109.1 ml/min.