Keimyung Med J.  2015 Dec;34(2):171-175. 10.0000/kmj.2015.34.2.171.

Hyperglycemic Hyperosmolar Syndrome Caused by Corticosteroid Therapy in a Patient with IgA Nephropathy

• Lee IH
• Kang GW

• KMID: 2224183
• DOI: http://doi.org/10.0000/kmj.2015.34.2.171

Abstract

Glucocorticoids are the most common cause of drug-induced diabetes mellitus or hyperglycemia. Hyperglycemic hyperosmolar syndrome (HHS) secondary to glucocorticoid treatment in patients with glomerular disease has rarely been reported in Korea. This paper describes a case of HHS after corticosteroid administration for the treatment of immunoglobulin A (IgA) nephropathy. A 56-year-old nondiabetic male with biopsy-proven IgA nephropathy was started on a combination therapy of an angiotensin converting enzyme inhibitor and oral prednisolone (60 mg, 0.8 mg/kg/day). Eight weeks after the initiation of steroid therapy, he was admitted with a one-week history of polydipsia, polyuria and general weakness. His laboratory tests revealed a serum creatinine level of 2.7 mg/dL, elevated blood glucose (1,221 mg/dL) and an increase in serum osmolarity (347 mOsm/kg H2O). Urinalysis showed 4+ sugars, 2+ proteins, and negative ketones. Prednisolone was tapered and he was administered with intravenous fluids, insulin and electrolytes. The patient was discharged with normoglycemia without the use of antidiabetic medications on the 18th hospital day. Patients who are taking corticosteroids for the treatment of primary glomerulopathy should be investigated for HHS promptly if they present with dehydration, general weakness and weight loss.

Keyword

Diabetes mellitus; Hyperglycemia; Steroids

MeSH Terms

Adrenal Cortex Hormones
Blood Glucose
Carbohydrates
Creatinine
Dehydration
Diabetes Mellitus
Electrolytes
Glomerulonephritis, IGA*
Glucocorticoids
Humans
Hyperglycemia
Immunoglobulin A*
Insulin
Ketones
Korea
Male
Middle Aged
Osmolar Concentration
Peptidyl-Dipeptidase A
Polydipsia
Polyuria
Prednisolone
Steroids
Urinalysis
Weight Loss
Adrenal Cortex Hormones
Blood Glucose
Carbohydrates
Creatinine
Electrolytes
Glucocorticoids
Immunoglobulin A
Insulin
Ketones
Peptidyl-Dipeptidase A
Prednisolone
Steroids