Endocrine Abstracts

Introduction

Glucocorticoids are among the most widely used treatments for controlling inflammatory or autoimmune diseases. However, their metabolic side effects are not negligible, particularly on carbohydrate metabolism. Corticosteroid-induced diabetes is an identity frequently found in the clinic. Its occurrence during pregnancy can affect the maternal and foetal prognosis. After the illustration of a clinical case, we will discuss the definition, risk factors and treatment of cortico-induced diabetes during pregnancy.

Observation

Q.B 36 years old, followed since 2003 for lupus nephropathy class 2 under corticotherapy and Immurel with the notion of several relapses and self-medication, known hypertensive under dual therapy, 6G2P with a history of 3 miscarriages and 3 neonatal deaths. Patient admitted to our department for Added Preeclampsia on a pregnancy of 26SA+6 days, with proteinuria at 5.5 g /24 h on the biological assessment. The use of corticosteroids was accompanied by a frank glycemic imbalance with postprandial hyperglycemia greater than 2 g/l and normal glycated hemoglobin at 5.5% which defines corticosteroid-induced diabetes. The patient was put on Lantus in the evening and rapid insulin therapy. Glycemic imbalance, the presence of hypertension, the existence of renal impairment and corticosteroid therapy at a dose higher than 20 mg/d were all factors that affected the foetal prognosis and fetal death in utero was declared at tenth day of hospitalization.

Conclusion

The beneficial effects of glucocorticosteroids are sometimes outweighed by significant deleterious effects such as corticoid-induced diabetes. The diagnostic criteria and therapeutic objectives are close to those for type 2 diabetes, its occurrence during pregnancy increases foetal and neonatal morbimortality, and diabetes in general, its management remains disparate due to the absence of evidence-based recommendations.