Insulin-dependent diabetes mellitus in which glycemic control was improved during pregnancy but deteriorated after delivery with the occurrence of postpartum thyrotoxicosis: a case report.
We report a patient, a twin, with diabetes mellitus whose hyperglycemic state fluctuated during the course of the pregnancy and the subsequent delivery. She was diagnosed as having slowly progressive IDDM because of her clinical course and the findings of serum positive ICA/CF, positive HLA-DR4 and disconcordance of diabetes mellitus with her identical twin. Insulin therapy was not initially needed in the first two years because the endogenous insulin secretion was not completely reduced. After two years of insulin therapy the patient became pregnant. Her glycemic control was remarkably improved without changes in dietary intake and insulin dosage. After delivery glycemic control deteriorated after delivery with the occurrence of postpartum thyroiditis. Urinary excretion of CPR was increased during pregnancy but decreased after delivery. ICA/CF in serum were persistently detected in the whole observation period. It seems that the improved glycemic control during pregnancy was caused by the reduction in the autoimmune reaction and the deterioration in glycemic control during the postpartum period was induced by the acceleration of the autoimmune reaction by the same mechanism of postpartum autoimmune thyroiditis.
Majima
T
T
First Department of Internal Medicine, Osaka Medical College, Japan.
Takamatsu
J
J
Isotani
H
H
Majima
M
M
Sakane
S
S
Yoshida
S
S
Sasaki
E
E
Taka
T
T
Kitazawa
A
A
Ohsawa
N
N
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism*; D003927:Diet, Diabetic; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism*; D011644:Puerperal Disorders / Q000276:immunology / Q000503:physiopathology*; D013971:Thyrotoxicosis / Q000276:immunology / Q000503:physiopathology*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006680:HLA Antigens; D007328:Insulin