Endocrine Abstracts

Introduction: Diabetes stemming from pancreatic causes constitutes 0.5% of diabetes cases (1–2). It is defined as ’other specific types of diabetes resulting from exocrine pancreas impairment.’ Through this case report, we elucidate the distinctive clinical features of chronic calcifying pancreatitis-related diabetes.

Case report: A 31-year-old male with a diabetic family history and a history of occasional alcohol consumption, is presenting with exocrine pancreatic insufficiency for the last 9 months. Characterized by diffuse abdominal pain, malabsorption-type diarrhea, concomitant onset of cardinal symptoms, and a weight loss of 14 kg over a year. Diabetes was revealed during the weight loss investigation. Clinical examination showed epigastric tenderness on palpation, capillary blood glucose at 5.9 g/l without ketonuria. Biochemically, fasting blood glucose was 2.5 g/l, eGFR at 123ml/min, HbA1c at 16.4g/dl, along with hepatic cytolysis and cholestasis. The infectious panel yielded negative results. The diagnosis of Chronic Calcifying Pancreatitis (CCP) was considered due to clinical and biological manifestations of exocrine insufficiency, weight loss, diabetes, and morphological findings. Notably, the pancreatic CT scan indicated a predominantly atrophic appearance of the entire pancreas with numerous micro and macro calcifications, along with dilation of the common bile duct and intrahepatic bile ducts, and findings consistent with calcifying pancreatitis without signs of glandular necrosis on magnetic resonance cholangiopancreatographic (MRCP). Given the indications of insulin deficiency, the patient was placed on insulin therapy using a basal-bolus strategy, and pancreatic enzyme supplementation was introduced. There were no manifestations of macroangiopathy or microangiopathy.

Discussion: Diagnosis of pancreatic diabetes is frequently delayed, with a notably higher occurrence in chronic calcifying pancreatitis. It should be considered in the presence of early signs of insulin deficiency