Endocrine Abstracts

Introduction

Secondary diabetes mellitus is seen in 10 to 70% of cases depending on the endocrinopathy involved; it can be indicative of the disease and often associated with other metabolic disorders. We report the case of a patient with inaugural diabetic ketosis revealing hyperthyroidism.

Case report

It’s a 42-year-old patient with a history of gestational diabetes not followed 5 years ago, with diabetic inheritance in the brother and sister profile T2DM. Accepted for inaugural ketosis. On examination: the symptoms go back to 4 months with the onset of polyuropolydipsic syndrome with 3 nocturnal awakenings associated with urination burns and vaginal pruritus. The clinical examination revealed a goiter at the expense of the right lobe. The patient was in ketosis with normal renal and hepatic function, the infective workup is negative and the thyroid workup demonstrated hyperthyroidism with TSH at 0.01 mIU/l, T4 at 19.8 pmol/l and T3 at 7 pmol/l. Cervical ultrasound showed multiple nodules in the goiter classified as EU-TIRADS 4.3 and 2. Management of diabetes consisted of correcting ketosis and putting on premix insulin. As well as a treatment of the etiology, synthetic antithyroid drugs dose of 20 mg/day. A fine needle aspiration of the nodules is planned.

Conclusion

Diabetes mellitus secondary to endocrinopathy is not that rare. The physiopathological mechanisms are diverse. In the presence of clinical manifestations giving rise to strong suspicion of an underlying endocrinopathy, the latter should be actively sought so as not to intensify the antidiabetic treatment without treating the primary disease.