Endocrine Abstracts

Introduction: Type 1 diabetes is an autoimmune condition resulting in insulin deficiency. Surveillance of other autoimmune disorders such as coeliac disease and hypothyroidism is common practice due to their higher co association. We describe a case of a 14 year old girl with 2 rarer autoimmune conditions; primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD)

Case summary: A 14 year old girl presented with abdominal pain, weight loss and tiredness for a few weeks. She had no history of polyuria or polydipsia, jaundice, diarrhoea or vomiting. On examination she had no hepatomegaly. Her blood tests revealed a moderate elevation of liver enzymes. Her liver ultrasound was normal. A month later she was diagnosed with type 1 diabetes. Her liver functions remained elevated therefore was referred to the regional liver unit. Further investigations confirmed a diagnosis of PSC. She was started on ursodeoxycholic acid with improvement in liver functions. Her diabetes was managed initially through multiple daily injections and thereafter by patch pump. She maintained excellent time in range. She was then actively screened for IBD. Her faecal calprotectin was very elevated. She then underwent biopsies which confirmed a diagnosis of IBD. She was started on medications for the same. In a space of 6 months she was diagnosed with 3 chronic conditions all managed by different specialists. 2 years on she remains in good health with normal liver functions, excellent time in range on ambulatory glucose profile and improving faecal calprotectin.

Discussion: Conditions like IBD and PSC can co exist albeit not routinely screened for in type 1 diabetes due to their extremely low prevalence rates. Our patient presented with raised liver function tests prior to her diabetes symptoms and therefore was diagnosed with PSC independently rather than through screening. Once a diagnosis of PCS was confirmed she was screened for IBD through faecal calprotectin due to reported prevalence rates of IBD up to 80% in patients with PSC. This presentation does not make a case for routine screening of liver functions testing in new diagnosis of type 1 diabetes but could be considered if abdominal symptoms remain unexplained.