Endocrine Abstracts

The hepatic autoimmune diseases are rarely associated with type 2 diabetes mellitus (T2DM). Instead, it’s more often encountered in people with type 1 diabetes mellitus in the context of polyglandular autoimmune syndrome (PAS). A 64-years old female diagnosed with T2DM for 8 years, hypertension and dyslipidemia currently under treatment with Dapagliflozin/Metformin 50/1000 mg twice daily, presented for her periodic diabetes consult complaining of marked fatigability and asthenia. The lab exams revealed: thrombocytopenia (47x10³/mm³), hepatocytolysis (GOT=424.14U/l; GPT=371.11U/l), cholestasis, elevated ESR and CRP, a protein electrophoresis pattern with decreased albumin and elevated γ-globulin and A1c=6.76%. The viral etiology was excluded. The abdominal ultrasound displayed marked splenomegaly, portal hypertension, slightly dilation of the intrahepatic bile ducts and increased caudate lobe. Due to hepatic status, the statin treatment was stopped, a switch from Dapagliflozin/Metformin to Glipizide was made and the patient was referred for a gastroenterology consult. The immunological profile was consistent with positive anti-nuclear and intense positive anti-mitochondrial M2 and M2-3E antibodies sustaining the diagnosis of an overlap syndrome with primary biliary cholangitis (PBC) and type 2 autoimmune hepatitis. The immunosuppressive treatment with Azathioprine 150 mg/day was initiated alongside ursodeoxycholic acid, L-arginine and Silymarin which led to significant improvement in the symptoms and lab exams. A subsequent dermatological consult established also a diagnosis of scalp psoriasis. The glycemic control under Glipizide was good with A1c <7% until present. This case illustrated a rare association of an overlap syndrome consisting of type 2 AH and PBC in an old female with type 2 diabetes. Despite immunosuppressive treatment and the conversion from dual to Glipizide monotherapy, the patient maintained a good glycemic control, emphasizing the role of this sulfonylurea in the management of the type 2 diabetes and liver diseases.