Diabetic ketoacidosis as first presentation of undiagnosed pancreatic cancer in an octogenarian.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Minh V Le, Spiros Fourlanos, Rahul D Barmanray
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Abstract

Summary: Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus (DM) that can theoretically occur in people of any age. While DKA can typically be the first presentation of type 1 DM in younger people, a first presentation is rare in older adults. Pancreatic cancer often manifests with new DM or hyperglycaemia, but very rarely as DKA. We report a case of an 89-year-old woman who was incidentally diagnosed with DKA during workup for an unwitnessed fall. Her DKA was promptly managed, and she was subsequently diagnosed with metastatic pancreatic cancer. Given the advanced stage of her malignancy, the multidisciplinary team consensus was for a palliative approach. She passed away on day 10 of the admission. To our knowledge, this is the first report of a first DKA presentation as a manifestation of pancreatic cancer in an adult aged over 70 years. To date, there is no effective screening test for pancreatic cancer in the general population. However, new-onset DM in the appropriate context might indicate the need for further evaluation. While it is possible that unresectable tumours are identified, earlier diagnosis of DM with pancreatic cancer may facilitate more timely management, including earlier advanced care planning.

Learning points: A higher clinical suspicion for pancreatic cancer is required for older adults presenting with diabetic ketoacidosis without a previously diagnosed diabetes mellitus. A bi-directional relationship exists between diabetes and pancreatic cancer. Pancreatic cancer generally has a very poor prognosis due to its advanced stage at diagnosis and the lack of an effective screening test. New-onset diabetes in the appropriate context (such as weight loss) can indicate the need for further evaluation for underlying pancreatic cancer.

糖尿病酮症酸中毒是一名八旬老人未确诊胰腺癌的首发症状。
摘要:糖尿病酮症酸中毒(DKA)是糖尿病(DM)的一种并发症,理论上可发生于任何年龄的人群。在年轻人中,DKA 通常是 1 型糖尿病的首发症状,而在老年人中,首发症状则十分罕见。胰腺癌通常表现为新的糖尿病或高血糖,但很少表现为 DKA。我们报告了一例 89 岁妇女的病例,她在一次无目击的跌倒检查中被意外诊断为 DKA。她的 DKA 得到了及时处理,随后被诊断为转移性胰腺癌。鉴于她的恶性肿瘤已到晚期,多学科团队一致认为应采取姑息治疗方法。她在入院第 10 天去世。据我们所知,这是首次报道 70 岁以上的成年人因胰腺癌首次出现 DKA。迄今为止,在普通人群中还没有有效的胰腺癌筛查方法。不过,在适当的情况下,新发的 DM 可能表明需要进一步评估。虽然有可能会发现无法切除的肿瘤,但更早诊断出胰腺癌的 DM 可能有助于更及时地进行治疗,包括更早地制定晚期护理计划:学习要点:对于出现糖尿病酮症酸中毒而之前未确诊糖尿病的老年人,临床上需要对胰腺癌有更高的怀疑。糖尿病与胰腺癌之间存在双向关系。由于胰腺癌在确诊时已是晚期,且缺乏有效的筛查手段,因此预后通常很差。在适当的情况下(如体重减轻),新发糖尿病可提示需要进一步评估潜在的胰腺癌。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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