A Case of Type 1 Diabetes Associated with Diabetic Ketoacidosis and Basedow's Disease.

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  • Terashima Masahiro
    Division of Diabetes and Endocrinology, Jikei University Kashiwa Hospital
  • Katoh Shuichi
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
  • Akashi Toshihiko
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
  • Kurata Hideaki
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
  • Sasaki Takashi
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
  • Tohjo Katsunori
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
  • Utsunomiya Kazunori
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
  • Tajima Naoko
    Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine

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Other Title
  • 糖尿病性ケトアシドーシスにバセドウ病を伴って発症した１型糖尿病の１例
  • ショウレイ ホウコク トウニョウビョウセイ ケトアシドーシス ニ バセドウビョウ オ トモナッテ ハッショウ シタ 1ガタ トウニョウビョウ ノ 1レイ

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A 38-year-0ld woman who had had 4 children was found to have glycosuria during her first pregnancy. Glucose tolerance was abnormal during each pregnancy, but became normal when the patient was not pregnant. From about August 13, 2000, dry mouth and generalized malaise developed.She was examined at the emergency department of our hospital on August 16. Blood glucose was 311 mg/dl, and the urinary ketone reaction was strongly positive. Urinary pH was 7.242 and HCO3-was 7.4 mmol/l.Diabetic ketoacidosis was diagnosed, and the patient was admitted. The anti-GAD antibody was strongly positive (22, 600 U/ml), and the insulin autoimmune antibody was positive, indicating a diagnosis of type 1 diabetes.Slowly progressive insuli-dependent diabetes mellitus (SPIDDM) was suspected based on the disease course.HLA-DR antigens 2, 9, and 53 were noted. The patient also had diffuse goiter, elevated T3, decreased TSH, positive test results for anti-TSH receptor antibody, anti-TPO antibody, and antithyroglobulin antibody, and increased uptake on technetium-99 m-labeled scintigraphy. Basedow's disease was also diagnosed. Because type l diabetes was associated with Basedow's disease, the condition was classified as type III polyglandu. 1ar autoimmune syndrome (PGA). The characteristics of our patient indicated a relatively classic case of simultaneous onset of type 1 diabetes and Basedow's disease.The study of similar cases will hopefully improve our understanding of the etiology of this condition.

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