New Onset Diabetes Mellitus Following TIPS Procedure in a Non-Cirrhotic Patient

Presentation Number: SAT 632
Date of Presentation: April 1st, 2017

Jonathan Bennion*1, Herbert L Bonkovsky2 and K Patrick Ober1
1Wake Forest Baptist Medical Center, Winston Salem, NC, 2Wake Forest Baptist Medical Center, Winston-Salem, NC

Abstract

Background:

Prior studies have found altered levels of hormones involved in glucose metabolism following the creation of a transjugular intrahepatic portosystemic shunt (TIPS). We describe the onset of diabetes mellitus in a non-cirrhotic patient shortly after the creation of a TIPS.

Clinical Case:

A 66 year-old male with myelofibrosis, splenomegaly, and a history of colon cancer developed recurrent GI bleeding from esophageal varices. He underwent a transjugular liver biopsy and hepatic vein pressure measurements, at which time, he was found to have portal hypertension but minimal fibrosis on biopsy. A transjugular intrahepatic portosystemic shunt (TIPS) procedure was performed with embolization of varices of the left gastric veins. There were no reported complications, and the patient was discharged home following a brief hospitalization. Prior to TIPS, the hepatic venous pressure gradient was 26 mm Hg; after TIPS it was 9 mm Hg and the shunt was widely patent following the procedure.

This patient had no prior personal or family history of diabetes. His random serum glucose measurements ranged from 100 - 200 mg/dL over two years prior to his TIPS procedure.

Approximately three and a half weeks following the TIPS procedure, the patient reportedly went to his local hematologist/oncologist and his blood sugar was found to be 401 mg/dL. From there, he went to urgent care where his blood sugar was noted to be 350 and he was sent on to the emergency department where it was found to be 255. He reported fatigue from the day prior and had a mild increase in urination but was otherwise well-appearing and had a normal exam. He was eventually started on insulin at bedtime to control his hyperglycemia. He was seen and evaluated in endocrinology clinic and continued on insulin for a new diagnosis of diabetes mellitus.

Conclusion:

To our knowledge, this is the first report of new onset diabetes mellitus in a non-cirrhotic patient following the creation of a TIPS. Hyperinsulinemia and hyperglucagonemia following this procedure have been described previously among cirrhotic patients, likely due to a combination of increased secretion and decreased hepatic clearance of these hormones. Similar mechanisms, with a disproportionately elevated glucagon level, may account for the new diagnosis of diabetes in this patient.

 

Nothing to Disclose: JB, HLB, KPO