40
The
th Annual Meeting of March 30-31, 2019 The Endocrine Society and The Diabetes Association of the R.O.C. (Taiwan)
PE01
A WOMAN WITH STIFF-PERSON SYNDROME—AUTOIMMUNE POLYENDOCRINE SYNDROME TYPE 2 1
MEI-CHEN YEH, 1NAI-CHENG YEH, 1SHANG-GYU LEE, 1KAI-JEN TIEN, 1 CHEWN-YI YANG 1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chimei medical center, Taiwan, R.O.C.
A 41-year-old woman was seen in the emergency department(ED) at this hospital because of trunkal spasm and rigidity. The patient had been well until approximately 1 week before this ED visit, when spasms and rigidity developed in her trunk and neck. The muscle spasms and rigidity progressively worsened. One GD\ EHIRUH WKH (' YLVLW WKH VSDVPV OHG WR GLI¿FXOW\ LQ VLWWLQJ XS IURP EHG DQG VKH KDG GLI¿FXOW\ LQ walking. She came to the emergency department at this hospital. At ED, her serum glucose was 476mg/dL, and hyperglycemic chorea was the impression. Her serum ketone body was 0.8mmol/L and blood osmolality was 310 mOsm/kg. She was given 6 unit of insulin subcutaneously, normal saline hydration and diazepam intravenously, and then she was discharged from ED with the prescription of oral-form antidiabetic medicine, Metformin(500mg) twice daily after meal. And she was refer to endocrine outpatient clinic 2 days later. At endocrine outpatient clinic, her blood glucose was 230mg/dL, however, the spasms and rigidity in trunk and neck still existed. Hyperglycemic chorea is not likely. This patient mentioned that she was told to have suspected hyperglycemia during her pregnancy more than 10 years ago, and she was also told that her blood sugar returned to normal range after her pregnancy. She denied any other systemic disease except for the suspected hyperglycemia. She denied allergic to any medicine. She did not smoke, drink alcohol, or use illicit drugs. She denied family history of any systemic disease. On examination, the vital signs were normal, except for elevated heart rate. The abdomen was rigid due to muscle spasm without tenderness on palpation. Mild stared eyes were seen. The remainder of the examination was normal. The hematocrit, hemoglobin level, platelet count, creatinine, and GPT were normal. Other test were as follows: Hba1c 10.6 %, GAD-65 > 2000 U/mL. Thyroid hormones were check because mild stared eyes were noted. (T4: 9.2ug/dl, TSH 0.03uIU/ml, free T4 1.77ng/dL, anti-TPO 190.9IU/mL). Thyroid sonography showed mild enlargement of bilateral lobes of thyroid gland with mild increased vascularity. I131 uptake scan was performed and the thyroid uptake at 24 hour was 80%(Normal range 15%-25%), consistent with diffuse thyrotoxicosis. Glucagon test for suspected type 1 diabetes was performed and the result revealed C-peptide at 134
