Hypoglycemia as a symptom of adrenal dysfunction in patients with diabetes mellitus: rare but real situation
Authors:
Ludmila Brunerová 1; Jana Urbanová 1; Jan Brož 2
Authors‘ workplace:
Centrum pro výzkum diabetu, metabolismu a výživy, II. interní klinika 3. LF UK a FN Královské Vinohrady, Praha
1; Interní klinika 2. LF UK a FN Motol, Praha
2
Published in:
Vnitř Lék 2019; 65(4): 300-302
Category:
Overview
Recurrent, unexplained, eventually severe hypoglycemias in patients with type 1 diabetes mellitus (T1DM) may be rarely but yet associated with the onset of adrenal insufficiency (AI), present in approximately 0.5 % of patients with T1DM, appearing usually several years after diabetes diagnosis, usually in middle age and more frequently in women. Screening for AI in patients who complained of recurrent hypoglycemias, difficult to explain by common causes, was ineffective and therefore it is not recommended. Nevertheless, the possibility of manifestation of AI in connection with above mentioned cases in patients with T1DM should be taken into consideration and usual symptoms of AI such as weakness, lack of appetite, weight loss, orthostatic hypotension, hyperpigmentation or ions disorders should be examined.
Keywords:
adrenal dysfunction
Sources
- Betterle C, Morlin L. Autoimmune Addison’s disease. Endocr Dev 2011; 20: 161–172. Dostupné z DOI: <http://dx.doi.org/10.1159/000321239>.
- Broersen LH, Pereira AM, Jorgensen JO et al. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. J Clin Endocrinol Metab 2015; 100(6): 2171–2180. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2015–1218>.
- Joseph RM, Hunter AL. Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review. Semin Arthritis Rheum 2016; 46(1): 133–141. Dostupné z DOI: <http://dx.doi.org/10.1016/j.semarthrit.2016.03.001>.
- Løvås K, Husebye ES. High prevalence and increasing incidence of Addison’s disease in western Norway. Clin Endocrinol (Oxf) 2002; 56(6): 787.
- Bancos I, Hahner S, Tomlinson J et al. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol 2015; 3(3): 216–226. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(14)70142–1>.
- Kršek M. Pacient s adrenokortikální insuficiencí v ordinaci internisty. Interní Med 2011; 13(4): 163–166.
- Gabalec F, Čáp J. Adrenální insuficience. Vnitř Lék 2015; 61(10): 858–861.
- Kuo T, McQueen A, Chen TC et al. Regulation of Glucose Homeostasis by Glucocorticoids. Adv Exp Med Biol 2015; 872: 99–126. Dostupné z DOI: <http://dx.doi.org/10.1007/978–1-4939–2895–8_5>.
- Meyer G, Hackemann A, Reusch J et al. Nocturnal Hypoglycemia Identified by a Continuous Glucose Monitoring System in Patients with Primary Adrenal Insufficiency (Addison’s Disease). Diabetes Technol Ther 2012; 14(5): 386–388. Dostupné z DOI: <http://dx.doi.org/10.1089/dia.2011.0158>.
- Petersen KS, Rushworth RL, Clifton PM et al. Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison‘s disease--favourable response to dietary management: a case report. BMC Endocr Disord 2015; 15: 61. Dostupné z DOI: <http://dx.doi.org/10.1186/s12902–015–0058–6>.
- Diéguez Felechosa MD, Valdés Gallego N, García-Alcalde Fernández ML et al. Hypoglycemia as a manifestation of iatrogenic adrenal insufficiency due to topical steroids. Endocrinol Nutr 2013; 60(9): e21-e22. Dostupné z DOI: <http://dx.doi.org/10.1016/j.endonu.2013.01.005>.
- Chihaoui M, Grira W, Bettaieb J et al. The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency. Nutrition 2018; 45: 99–103. Dostupné z DOI: <http://dx.doi.org/10.1016/j.nut.2017.07.014>.
- Barker JM. Clinical review: type 1 diabetes associated autoimmunity: natural history, genetic associations, and screening. J Clin Endocrinol Metab 2006; 91(4): 1210–1217. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2005–1679>.
- Betterle C, Zanette F, Pedini B et al. Clinical and subclinical organ-specific autoimmune manifestations in type 1 (insulin-dependent) diabetic patients and their first-degree relatives. Diabetologia 1984; 26(6): 431–436.
- Eisenbarth GS, Gottlieb PA. Autoimmune polyendocrine syndromes. N Engl J Med 2004; 350(20): 2068–2079. <http://dx.doi.org/10.1056/NEJMra030158>.
- Dalin F, Nordling Eriksson G, Dahlqvist P et al. Clinical and Immunological Characteristics of Autoimmune Addison Disease: A Nationwide Swedish Multicenter Study. J Clin Endocrinol Metab 2017; 102(2): 379–389. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2016–2522>.
- Hardy KJ, Burge MR, Boyle PJ et al. A treatable cause of recurrent severe hypoglycaemia. Diabetes Care 1994; 17(7): 722–724.
- Phornphutkul C, Boney CM, Gruppuso PA. A novel presentation of Addison disease: hypoglycemia unawareness in an adolescent with insulin‐dependent diabetes mellitus. J Pediatr 1998; 132(5): 882–884.
- Passanisi S, Timpanaro T, Lo Presti D et al. Recurrent hypoglycaemia in type-1 diabetes mellitus may unravel the association with Addison‘s disease: a case report. BMC Res Notes 2014; 7: 634. Dostupné z DOI: <http://dx.doi.org/10.1186/1756–0500–7-634>.
- Armstrong L, Bell PM. Addison‘s disease presenting as reduced insulin requirement in insulin dependent diabetes. BMJ 1996; 312(7046): 1601–1602.
- McAulay V, Frier BM. Addison‘s disease in type 1 diabetes presenting with recurrent hypoglycaemia. Postgrad Med J 2000; 76(894): 230–232.
- Thomas JB, Petrovsky N, Ambler GR. Addison‘s disease presenting in four adolescents with type 1 diabetes. Pediatr Diabetes 2004; 5(4): 207–211. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1399–543X.2004.00056.x>.
- Sakane N, Yoshida T, Yoshioka K et al. Severe hypoglycaemia and type1 diabetes with isolated ACTH deficiency. Diabetes Care 1995; 18(12): 1621–1622.
- Schroter W, Arends J, Runte L et al. Hypoglycemia with loss of consciousness during insulin therapy as an initial symptom of Addison‘s disease. Report of 2 cases. Dtsch Med Wochenschr 1985; 110(21): 840–842. Dostupné z DOI: <http://dx.doi.org/10.1055/s-2008–1068915>.
- Likhari T, Magzoub S, Griffiths MJ et al. Screening for Addison‘s disease in patients with type 1 diabetes mellitus and recurrent hypoglycaemia. Postgrad Med J 2007; 83(980): 420–421. Dostupné z DOI: <http://dx.doi.org/10.1136/pgmj.2007.058321>.
- Kostev K, Dippel F, Rathmann W. Predictors of hypoglycaemia in insulin-treated type 2 diabetes patients in primary care: A retrospective database analysis. Prim Care Diabetes 2014; 8(2): 127–131. Dostupné z DOI: <http://dx.doi.org/10.1016/j.pcd.2013.10.001>.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
![Issue 4](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/e079c77cfe2515cc0f412f90397e0808.jpeg)
2019 Issue 4
Most read in this issue
- Primary and secondary insulin resistance
- Current view of treatment of hypoglycemia
- Diabetes mellitus 1. typu: etiologie a epidemiologie
- Diabetes in pregnancy: current ways of treatment