SHM Converge Scientific Abstract ePoster Gallery-A Sheep in Wolf's Clothing: Uncovering Glycogenic Hepatopathy

Pdf Summary

This case describes a 34-year-old woman with type 1 diabetes, hypertension, hypothyroidism, and polysubstance use disorder who presented with nausea, vomiting, diffuse abdominal pain, and tachycardia after running out of insulin. She was found to be in diabetic ketoacidosis with severe hyperglycemia (glucose 742 mg/dL), marked metabolic acidosis (pH 7.10, CO2 6 mmol/L, anion gap 36), and elevated β-hydroxybutyrate (11.3 mmol/L). Initial liver tests were abnormal, with elevated ALT, AST, and alkaline phosphatase.<br /><br />She was started on an insulin drip for DKA. By hospital day 2, her abdominal pain worsened and transaminases rose dramatically (ALT 769 U/L, AST 2738 U/L). CT of the abdomen showed marked hepatomegaly, with the right liver lobe measuring 24 cm. A broad evaluation for viral, autoimmune, and metabolic liver disease was negative. Because her liver enzymes improved rapidly with better glucose control, glycogenic hepatopathy was suspected and liver biopsy was deferred.<br /><br />Glycogenic hepatopathy is a reversible liver disorder caused by excessive glycogen accumulation in hepatocytes due to fluctuating glucose and insulin levels, most often seen in young patients with poorly controlled type 1 diabetes. It can mimic acute hepatitis or drug-induced liver injury, but typically resolves with glycemic stabilization and does not cause significant fibrosis or inflammation.<br /><br />This case highlights the importance of recognizing glycogenic hepatopathy in patients with poorly controlled T1DM and elevated transaminases, as early identification can prevent unnecessary invasive testing and guide treatment toward glucose control.

Asset Subtitle

Franklin Liu

Meta Tag

Author List Aparna Abhirami Rathnam, Elizabeth Awerbuch, Franklin Liu, Jazmin F. Mexia Cabrales

Category Clinical Vignettes

Concept Diabetic Ketoacidosis

Concept Glycogenic Hepatopathy

Concept Hyperglycemia

Concept Aminotransferase Elevation

Concept Glycogen Accumulation

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Franklin Liu

Track Adult

Keywords

glycogenic hepatopathy

type 1 diabetes

diabetic ketoacidosis

elevated transaminases

hepatomegaly

hyperglycemia

insulin drip

metabolic acidosis

liver enzyme elevation

glycemic control

Diabetic Ketoacidosis

Glycogenic Hepatopathy

Hyperglycemia

Aminotransferase Elevation

Glycogen Accumulation