ECE2016 Eposter Presentations Clinical case reports - Thyroid/Others (71 abstracts)
Diabetic gastroparesis – a pregnancy in jeopardy
Daniela Magalhães 1, , Rita Bettencourt-Silva 1, , Maria Manuel Costa 1, , Ana Saavedra 1, , Sandra Belo 1, , Joana Queirós 1 , Paula Freitas 1, , Gabriela Namora 3 , Nuno Montenegro 3 & Davide Carvalho 1,
1Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar de São João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal; 3Department of Obstetrics and Maternal and Fetal Health of Centro Hospitalar de São João, Porto, Portugal.
Introduction: Diabetic gastroparesis (DGP) is defined by delayed gastric emptying in the absence of mechanical obstruction caused by autonomic neuropathy. Only 5% of type 1 and 1% of type 2 diabetic patients combine the delay of gastric emptying with typical gastroparesis symptoms. This entity is usually identified in patients with least 10 years of diabetes evolution and is presented typically in the 4th to 5th decades of life in type 1 diabetes mellitus (T1DM). It is associated with marked glycemic lability and it has significant morbidity.
Case report: A 32-year-old woman with a history of T1DM with 13 years of evolution, with poor metabolic control due to noncompliance with A1c 8–9%. After one year of functional insulin therapy she has improved her median A1c to ≈6.5%. No target organ lesions were known. In the previous 6 months she was hospitalized two times due to nausea and vomits. She performed a scintigraphy that revealed serious gastric emptying delay (100% radiopharmaceutical retention at 3 hours) and an endoscopy that showed gastric stasis with large amount of food in the gastric cavity (11-hours fasting). She was diagnosed with DGP and initiated treatment with domperidone before meals. Although she was advised about the pregnancy contraindication, she became pregnant and presented with significant worsening of symptoms with food intolerance and electrolyte disturbances and was admitted to the hospital at 7 weeks+6 days (estimated gestation) of pregnancy. She started combined therapy with metoclopramide, domperidone, ondansetron, droperidol, erythromycin and dexamethasone. As she kept food intolerance and developed malnutrition, parenteral nutrition was initiated at 8 weeks+6 days. Given the lack of therapy response, pregnancy interruption at 10 weeks+2 days was decided after multidisciplinary assessment.
Conclusions: DGP can be associated with significant morbidity with weight loss, malnutrition and severe acid-base and electrolyte imbalances. Pregnancy in these patients can lead to death in extreme cases.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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