Introduction: The main widespread type of diabetes are type 1 and type 2 diabetes, and secondary causes must always be assessed if there is any suspicion.
Cushing Syndrom is one of the main causes of endocrine disorders causing diabetes, though it is rarely revealed by a ketosis.
We herein report the case of inaugural ketosis in a patient with an iatrogenic Cushing Syndrom.
A 27-year-old man was referred to us for inaugural diabetic ketosis. There is a family history of type 1 diabetes in the brother, and no personal medical history. He reported the cardinal signs of diabetes with weight loss, asthenia, polyuria and polydipsia. Physical examination showed a normal blood pressure, a body mass index of 27.42 kg/m2, and no signs of neuropathy or complications of diabetes. He had thin skin, purple stretch marks and multiple bruises. The patient was taking 2.25 milligrams of betamethasone daily for four years in order to fain weight, resulting in a Cushing Syndrom with iatrogenic corticotropin deficiency. On complementary exams, there were no signs of infection, the electrocardiogram was normal, the glycated hemoglobin was at 10.7%, kidney and liver testings were normal, and thyroid-stimulating hormone levels were at 2.32 µIU/ml. The ketosis was cured after one injection of ten international Units of fast-acting insulin, and he was put under a basal-bolus injection regimen and 60 milligrams per day of hydrocortisone with gradual tapering.
Discussion: In this patient, the type of diabetes is unclear as the inaugural ketosis is rarely observed in glucocorticoids induced diabetes, and type 1 diabetes is less likely considering the fast response to insulin, and must be excluded first before concluding to an endocrine disorder. For further investiations, testing was realized for Glutamic Acid Decarboxylase 65 and protein tyrosine phosphatase antibodies, the results are still in progress. Follow up on this case and his insulin needs after glucocorticoid tapering and discontinuation will lead to the etiologic diagnosis of diabetes mellitus.
05 Sep 2020 - 09 Sep 2020