Reversible Diabetes Mellitus due to Obstructive Jaundice

Kim, Young Woo; Han, Ho Seong; Choi, Yong Man

Abstract

BACKGROUND: There have been few reports showing direct correlation between obstructive jaundice and diabetes mellitus (DM). We were able to incidentally observe the reversal of DM to normal glucose metabolism after relieving obstruction of bile duct in our patients. So, we present our cases and speculate on the pathophysiology of this phenomenon.
METHODS
Four patients showed reversible DM due to obstructive jaundice from August 1993 to June 1997. We reviewed their medical records retrospectively. We ruled out other causes of glucose intolerance such as primary DM, sepsis, previous history of chronic liver disease, previous history of chronic pancreatitis, etc..
RESULTS
The first patient was a sixty-year-old male presenting obstructive jaundice due to distal blie duct cancer. The second patient was a 53-year-old female developing jaundice due to common hepatic duct stricture after laparoscopic choloecystectomy. The third patient was a 68-year old male with pancreas head cancer and glucose intolerance. The fourth patient was a 54-year-old male also developing jaundice due to common hepatic duct stricture after laparoscopic cholecystectomy. Insulin was necessary to maintain normal serum glucose level for two to three weeks postoperatively. After being relieved of jaundice, all patients showed normalized serum glucose levels.
CONCLUSION
Our study suggests that obstructive jaundice itself may cause DM. So, glucose intolerance may be a useful indicator of diseases causing obstructive jaundice. However, the pathophysiology of DM with obstructive jaundice has not yet been clarified. Further studies are needed to determine the relationship.