J Korean Diabetes > Volume 18(2); 2017 > Article
The Journal of Korean Diabetes 2017;18(2):125-133.
DOI: https://doi.org/10.4093/jkd.2017.18.2.125    Published online July 31, 2017.
불량한 혈당 조절을 주소로 내원한 제2형 당뇨병 환자에서 우연히 진단된 제1형 다발성 내분비선종의 1예
이용훈, 이유창, 이정은, 이솔재, 정수진, 김종화
A Case of Multiple Endocrine Neoplasia Type 1 in Type 2 Diabetes Mellitus with Poor Glycemic Control.
Yong Hoon Lee, Yu Chang Lee, Jung Eun Lee, Sol Jae Lee, Su Jin Jeong, Chong Hwa Kim
Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea. drangelkr@hanmail.net
Abstract
The primary causes of uncontrolled diabetes are poor life-style, infection, ischemic heart disease and inappropriate usage of oral anti-diabetic agents and insulin. Supplementary causes are stroke, acute pancreatitis and endocrine diseases. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by primary hyperparathyroidism, pituitary neoplasia, and foregut lineage neuroendocrine tumors, and is associated with increased glucose levels. We present a case of a 69-year-old woman who had polyuria, polydipsia, weight loss and hyperglycemia over 6 months. She had hypertrophy of the face, hand, and foot, and active bleeding and large folds were observed in the stomach and duodenum upon esophagogastroduodenoscopy. She also had high levels of IGF-1 and gastrin and got the failure of growth hormone suppression after an oral glucose load (75 g). These findings suggested a diagnosis of acromegaly and gastrinoma, which was clinically diagnosed along with MEN 1. The patient improved glycemic control and symptoms after being treated with somatostatin analogues and insulin therapy over a 5-month follow-up period. Here, we report a case of MEN 1 in type 2 diabetes mellitus with a poorly controlled blood glucose level. Clinicians should consider endocrine disease in patients with poor glycemic control in diabetes.
Key Words: Acromegaly, Gastrinoma, Multiple endocrine neoplasia type 1, Type 2 diabetes mellitus


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