Glycogen hepatopathy

This case report highlights a challenging clinical case called glycogen hepatopaty-induced acute hepatitis. This clinical condition is often underdiagnosed or misdiagnosed even by consultant specialists eventually hampering patient management and outcome. Glycogen hepatopathy is a very rare and forgotten complication of poorly controlled type 1 diabetes mellitus. Glycogen hepatopathy may also present in type II diabetes mellitus, especially when managed with high doses of insulin. Although it is a benign condition, it is rarely diagnosed in a timely manner. It is characterised by hepatomegaly causing abdominal pain due to stretch on the liver capsule causing capsulitis, and derangement of liver enzymes. We report a case of a 44-year-old male truck driver who presents to ED with right upper quadrant pain in the context of uncontrolled type II diabetes mellitus for the last two years. Glycogen hepatopathy is caused by wide fluctuations of blood glucose and treatment with large doses of insulin. High levels of insulin due to uncontrolled diabetes mellitus or high doses for treatment lead to excess glucose movement into hepatocytes via independent passive diffusion.

Author(s) Details:

Adel Ekladious
Acute Medical Unit, Canberra Hospital, ACT Health, Australia, University of Western Australia, Australia and Australian National University, Australia.


Also See : Comorbid Primary Biliary Cholangitis and Systemic Lupus Erythematosus : A Part from the Book Chapter : Association of Systemic Lupus Erythematosus and Primary Biliary Cholangitis


Recent Global Research Developments in Glycogenic Hepatopathy: Insights from a Narrative Review

Glycogenic hepatopathy (GH) is a rare complication associated with poorly controlled diabetes mellitus. It is characterized by transient liver dysfunction, elevated liver enzymes, and hepatomegaly due to the reversible accumulation of excess glycogen in hepatocytes [1]. Here are some key points from recent research:

Pathophysiology and Differentiation:

  • GH shares clinical similarities with non-alcoholic fatty liver disease (NAFLD). Both conditions can be challenging to differentiate.
  • NAFLD is increasingly common in type 1 diabetes (T1D) due to factors like overweight and obesity linked to the metabolic syndrome.
  • GlyH, on the other hand, is rare but often seen in young individuals with T1D and extremely brittle metabolic control.
  • Distinguishing between NAFLD and GlyH is crucial for clinical care, as NAFLD is associated with cardiovascular and kidney diseases, while GlyH is considered self-limiting.

Underlying Mechanisms and Diagnosis:

  • The exact pathogenesis of both hepatopathies remains unclear.
  • Recent studies have identified varying degrees of fibrosis in GlyH, emphasizing the need for further research.
  • Newer MRI protocols can help differentiate between NAFLD and GlyH, aiding in accurate diagnosis and management [2,3].
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References

  1. García-Suárez C, Álvarez Suárez B, Castro Ortiz E, et al. Glycogenic hepatopathy: a rare and reversible cause of elevated transaminases in diabetic patients. Case report. Revista Espanola de Enfermedades Digestivas. 2015 Feb;107(2):111-112. PMID: 25659393.
  2. Sherigar, J. M., De Castro, J., Yin, Y. M., Guss, D., & Mohanty, S. R. (2018). Glycogenic hepatopathy: a narrative review. World journal of hepatology, 10(2), 172.
  3. Tess Chamakkala, Santh Silparshetty, LBODP039 Glycogenic Hepatopathy- An Underrecognized Complication Of Diabetes, Journal of the Endocrine Society, Volume 6, Issue Supplement_1, November-December 2022, Pages A267–A268, https://doi.org/10.1210/jendso/bvac150.549

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