A Pediatric Case of Abrupt-Onset, Autoantibody-Negative Diabetes With Marked Insulin Resistance Concomitant With COVID-19
| Autor: | Kelly A. Hicks, Alfonso Hoyos-Martinez, Tracy Patel, Jennifer Bell, Yuezhen Lin |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Diabetic ketoacidosis Case Study business.industry Endocrinology Diabetes and Metabolism Pancreatic islets Autoantibody medicine.disease Gastroenterology medicine.anatomical_structure Insulin resistance Polyuria Diabetes mellitus Internal medicine Internal Medicine medicine medicine.symptom Ketosis business Polydipsia |
| Zdroj: | Clinical Diabetes : A Publication of the American Diabetes Association |
| Popis: | By December 2020, coronavirus disease 2019 (COVID-19) had claimed the lives of more than 200,000 in the United States alone, with more than 10.8 million people infected (1). As the numbers grow, we continue to learn that this disease has wide-ranging outcomes of varying severity affecting multiple organs (2). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel virus causing COVID-19, uses the ACE 2 receptor to enter human cells. This receptor is expressed in 15 different human organs (3). Moreover, it is avidly expressed in the pancreatic islets, but not on the exocrine pancreas, suggesting that the virus may directly affect β-cells (3). The full effects of COVID-19 on diabetes are yet to be determined, but worse outcomes have been reported in adult patients with obesity, impaired glucose metabolism, and diabetes (4). Furthermore, new-onset diabetes, ketosis in people without diabetes, diabetic ketoacidosis (DKA), and worsening metabolic complications in patients with known diabetes have all been reported in adults with COVID-19 (5–7). Some experts have proposed a diabetogenic effect of COVID-19, perhaps presenting as a novel type of diabetes (8). Herein, we describe a case of new-onset, autoantibody-negative diabetes presenting with DKA and marked insulin resistance in an otherwise healthy, nonobese adolescent. A 12-year-old previously healthy White Hispanic boy presented with a 1-week history of abrupt-onset polyuria, polydipsia, headache, and fatigue. He had no weight loss, fever, cough, anosmia, or diarrhea. Laboratory testing revealed DKA, with a blood pH of 7.04, glucose of 381 mg/dL, C-peptide level of 0.6 ng/mL, β-hydroxybutyrate level of 8.2 mmol/L, A1C of 11.3%, and a positive nasopharyngeal reverse transcription-PCR (RT-PCR) test for SARS-CoV-2. There was evidence of pancreatic inflammation (lipase 179 units/L [normal range 15–110]), but no elevation in systematic inflammatory markers, and all autoantibody tests for autoimmune diabetes were negative (Table … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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