Non-alcoholic steatohepatitis (NASH) is a clinical entity characterized by the infiltration of fat into the liver associated with hepatic inflammation. The etiology is unknown, however its most frequently observed in patients with type 2 diabetes mellitus (DM 2), obesity or insulin resistance. DM 2 is an independent risk factor for the progression of NASH. Usually there are no symptoms, so it is not possible to estimate its prevalence. The treatment focuses on the control of associated diseases such as DM 2 and obesity. A 65-year-old woman without alcohol or toxicophilic abuse, without obesity (BMI of 22.7) and with clinical history of immune thrombocytopenic purpura, DM 2 (controlled under diet), hypertension and cystic lesion of the pancreas (5 years before biopsy compatible with mucinous lesion). Due to the increasing of the pancreatic lesion, with dilatation of the wirsung canal, the patient was submitted to body-caudal pancreatic resection. During the intraoperative period, the liver presented with a cirrhotic pattern, and liver biopsy was performed. Histology showed steatohepatitis, with fibrosis grade 5/6 and focal balloonization of hepatocytes. Additional study: ANA 1/160, remaining autoimmunity (AMA, SMA, LKM and antibodies anti-liver antigens) and viral serologies (HIV, hepatitis B and C) negative. After the surgery, insulin therapy was initiated with good metabolic control. The patient did not present micro or macrovascular complications. The present case describes a diabetic patient with an incidental diagnosed cirrhotic liver caused by NASH. The association of NASH and DM2 is present in more than 75% of the diabetics and in this case other related conditions (as obesity, hyperlipidemia, insulin resistance, and drugs) were excluded. The early intervention in DM 2 is crucial, in order to reduce related pathologies and their progression especially in this case with silent steatohepatitis and cirrhotic liver.
20 - 23 May 2017
European Society of Endocrinology