Endocrine Abstracts

Introduction

COVID-19 can precipitate hyperglycaemic emergencies like Hyperosmolar Hyperglycaemic State (HHS) in patients with or without DM. It is currently hypothesized that COVID-19 may have a diabetogenic effect in addition to the stress-related response of glucose metabolism in severe illness. Dexamethasone reduces mortality in people with COVID-19 who require ventilation or oxygen therapy but can impair glucose metabolism. We present a case with HHS precipitated by COVID-19 infection and corticoid treatment in a patient without prior history of Diabetes Mellitus.

Case presentation

We present a clinical case of a woman 85 years old, obese that was admitted to the emergency unit in coma. Medical history: She has been treated for high blood pression and bronchial asthma for 30 years but not known before for diabetes mellitus. No family history of diabetes. In early December 2020, she was diagnosed with COVID-19. Because of severe Covid-19 form, she was treated with antibiotics, oxygen therapy and dexamethasone 8 mg/day for 10 days. After one month, she was improved but she complained progressive fatigue and weakness, polyuria-polydipsia, anorexia. Every symptom was attributed to Covid-19 and it was hoped that over time they would disappear. But symptoms have been aggravated during the last 2 weeks and she was presented in emergency unit in coma. Laboratory examinations: Hyperglycaemia (1280 mg/dl), high level of urea and creatinine (222.4 mg/dl and 2.88 mg/dl) respectively, high level of cardiac enzymes (LDH693, Ck566 u/l, Troponin1, 86 ng/ml), High PCR16 mg/dl, high D-dimer418 mg/dl(<198) normal level of SGPT, SGOT. Na+153 mmol/l, K+4.3 mmol/l. WBC32000 with high neutrophils and low lymphocytes. Mild normochromic normocytic anaemia. HGA: Ph7.4 but O2 saturation83%. High plasma osmolarity = 402 mOsm/kg. Imaging examinations: Head-CT: without acute intracranial lesions. Lungs CT: Interstitial opacities in absorption with invadation of less than 10% of lung tissue, aspect in favour of post Covid-19 changes. After the examinations, it was concluded that, the situation was related to HHS precipitated by COVID-19 infection and corticoid treatment in a patient without prior history of Diabetes Mellitus. Initially she was treated in Intensive Unit Care with iv liquids, oxygen therapy, anticoagulants, antibiotics, insulin therapy. After 3 days, stabilised, she was transferred in the Endocrinology Department for further treatment. After 10 days in a good general condition, she was discharged from the hospital with endocrinologist follow-up under insulin therapy.

Conclusion

COVID-19 together with dexamethasone treatment can precipitate Hyperosmolar Hyperglycaemic State, a life threatening situation, in a patient without diabetes. All physicians must be aware about this situation, to prevent it.