Endocrine Abstracts

Introduction: Although a strong association between diabetes mellitus and carcinogenesis is suggested, their relationship is still debated. Diabetic ketosis is an acute metabolic complication caused by absolute or relative insulin deficiency. It is rarely a revealing condition of a malignant tumor.

The aim of our study was to determine clinical and paraclinical particularities of patients with malignant tumors revealed by a diabetic ketosis.

Patients and Methods: We conducted a retrospective study in patients who were admitted for a diabetic ketosis between 2015 and 2019 and in whom a malignant tumor was revealed. Clinical, biological and radiological features were collected.

Results: Our study included six patients (4 men and 2 women) with an average age of 73.6 ± 15.6 years [Extremes: 48–89]. A family history of hypertension and diabetes was present in three patients. Three patients had type 2 diabetes mellitus. Symptoms were dominated by weight loss, weakness and anorexia in all cases and by epigastralgia in only one. On clinical examination, patients had a mean body weight of 55.3 kg, a mean body mass index of 21.36 kg/m², a mean systolic blood pressure of 106 mmHg and a mean diastolic blood pressure of 66 mmHg. Dehydration was present in one patient and only one patient had a Glasgow score of 12/15. The mean value of capillary glycemia was 4.10 g/l and all patients had ketonuria. The mean level of HbA1c was 11% [extremes: 9–14.8%]. Renal and hepatic functions were normal. Obvious precipitating factors were not present. Tumor markers CA-19–9 were elevated in one case and CA-125 in another case. Investigations revealed pancreatic carcinoma (2 cases), kidney carcinoma (1 case), hepatic carcinoma (1 case) stomach carcinoma (1 case) and brain carcinoma (1 case). Three patients had metastases.

Conclusion: Diabetes mellitus and cancer are common diseases. Their coexistence is possible and may be explained by several factors. This case series study highlights the possibility of coexisting cancer as a ketosis precipitating factor in type 2 diabetic patients and in undiagnosed diabetic patients especially in elderly with a poor general condition and in the absence of obvious precipitating factors.