Endocrine Abstracts

Introduction: Gastroparesis associated with diabetic autonomic neuropathy is an underdiagnosed complication, although relatively common in diabetes. It is more prevalent in type 1 Diabetes Mellitus (DM1) with more than ten years of disease and especially in patients with poor metabolic control.

Clinical case: Female, 37 years old, DM1 with 17 years of evolution with poor metabolic control (HbA1c 9.3%) and several microvascular complications such as proliferative retinopathy with decreased visual acuity and diabetic nephropathy with end-stage renal failure, on hemodialysis for about 9 years (initially with unsuccessful living donor transplant). The patient presents an important intestinal dysautonomic component, characterized by chronic diarrhea of over 6 months and more recently with gastroparesis (2 weeks). Admitted in January 2019 after a right frontoparietal hemorrhagic stroke with mass effect and deviation of the midline, without indication for neurosurgery, resulting in left upper limb plegia, left lower limb paresis and associated left central facial paresis. During hospitalization, food intolerance was observed, with no improvement to the different prokinetic therapy instituted (metoclopramide, domperidone, clebopride, erythromycin and ondansetron), requiring total parenteral feeding. Among the tests carried, the patient was submitted to high digestive endoscopy and abdominal CT without contrast, which did not reveal relevant changes. Only after glycemic control was achieved was it possible to progressively reverse the gastroparesis condition.

Conclusion: Diabetic gastroparesis is a complex disease that is difficult to control, with diagnostic workup hampered by the extensive differential diagnosis, associated with an increased rate of hospitalization that requires a multifaceted approach.