Endocrine Abstracts

Introduction: Fibrocalculous pancreatic diabetes is an uncommon type of diabetes mellitus due to chronic calcific non-alcoholic pancreatitis. It is associated to several particularities based on glycemic control and the occurrence of degenerative and metabolic complications, in addition to chronic pancreatitis complications.

Observation: A 17-year-old male, with no familial history of diabetes and no alcohol consumption, was hospitalized in 1989 for ketone prone diabetes. He has reported abdominal pain for about 2 years, in a chronic and relapsing mode associated with progressive weight loss. Physical examination revealed no particularities. Biologic investigation has shown a raised random blood glycemia level. The urinalysis showed massive glycosuria and ketonuria. The abdominal X-ray showed multiple pancreatic calcifications. The 25-year follow-up showed a difficulty to obtain a good glycemic control despite of a good treatment adherence. Improvement of glycemic control was obtained by the use of insulin analogues. No diabetic ketoacidosis has occurred during the evolution. Diabetic retinopathy has been diagnosed and treated after 10 year-duration of DM. In 2009, acute pancreatitis with worsening signs of malabsorption was documented. Abdominal computed tomography scans revealed chronic calcifiant pancreatitis with porto-spleno-mesenteric venous thrombosis. No pancreatic tumor was found. The etiologic exploration of thrombosis revealed a resistance of activated protein C. The patient was hence treated by pancreatic enzyme granules and a lifelong anti coagulation therapy. The last biologic control showed an improved glycemic control without any malabsorption sign. Abdominal CT showed a complete involution of pancreas and a portal cavernoma.

Conclusion: This case presentation highlights how important is to suspect fibrocalculous pancreatic diabetes especially in the presence of chronic abdominal pain. The follow-up of such patients should be focused not only on diabetes clinical and biological markers, but also on pancreatitis complications.