Endocrine Abstracts

JOINT3931

Autoimmune hepatitis (AIH) is a progressive, chronic liver disease characterized by unresolving hepatocellular inflammation of autoimmune origin and varied clinical presentation. In type 2 diabetes mellitus (DM), the prevalence of AIH seems to be the same as in general population. Usually, patients with T2DM and AIH have a shorter duration of diabetes, are mostly women with increased liver enzymes and require higher insulin doses. A 42 -years old female with a history of gestational diabetes, hypertension and deep vein thrombosis presented in our service for a consult. At presentation: BMI=34.52kg/m², WC=112cm; Pulse=72/min and BP = 140/90mmHg. The lab exams showed: marked inflammatory syndrome with CRP=209.58 (NV <0.5mg/dl), neutrophilic leukocytosis, mild dyslipidemia, low vitamin D and iron levels, hyperglycemia (BG=186mg/dl) with A1c=7.3% and mild increased LDH and γ-GGT. The microvascular complication screening revealed peripheral sudomotor dysfunction by Sudoscan testing. Treatment with Metformin 750mg twice daily, Rosuvastatin 10mg/day and vitamin D 5000IU/day for 3 months was initiated and the patient was referred for a gastroenterology consult. The diagnosis of type 1 autoimmune hepatitis was established after exclusion of viral etiology and based on the positive ANA of 1/160 with intense positive anti-DFS70 (dense fine speckle, 70kDa molecular weight) and equivocal anti interferon-inducible protein Ro-52. The thyroid hormones were within normal ranges, but the thyroid antibodies were not measured. The immunosuppressive treatment with Azathioprine 150mg/day was initiated alongside Silymarin. After 6 months, decreases in BMI (-4.41kg/m²), WC (-14cm) and A1c (-1.6%) were noted. The inflammatory syndrome resolved, but the LDL cholesterol was above target, so the statin dose was increased. The particularity of this case consists in marked inflammation with mild cholestasis, normal ALAT and ASAT and no symptoms. The treatment with Metformin and lifestyle optimization led to significant weight loss and improved glycemic control.