title: Early onset insulin-dependent diabetes mellitus as an initial manifestation of aceruloplasminaemia.
abstract: BACKGROUND
  Aceruloplasminaemia is an autosomal recessive disorder caused by specific mutations in the ceruloplasmin gene. Aceruloplasminaemia is clinically characterized by diabetes mellitus, pigment degeneration of the retina, and neurological abnormalities, such as cerebellar ataxia, extrapyramidal signs, and dementia. We present a patient with aceruloplasminaemia who, until progressive neurological abnormalities were noticed, had been treated for more than 30 years as having Type 1 diabetes mellitus requiring multiple insulin injection therapy.
  
  
  METHODS
  The patient was a 58-year-old man. At the age of 23 years, he developed diabetes that required multiple insulin injection therapy. At the age of 39 years, he was commenced on continuous subcutaneous insulin infusion (CSII) therapy. Despite CSII therapy, the patient's blood glucose levels were poorly controlled (HbA(1c), approximately 9.5%). He was diagnosed as having aceruloplasminaemia at 58 years of age when he presented with progressive cerebellar ataxia, extrapyramidal signs of recent onset and pigment degeneration of the retina.
  
  
  CONCLUSIONS
  It is possible that some diabetic patients with aceruloplasminaemia are mistakenly diagnosed as having Type 1 diabetes mellitus, as they have reduced insulin secretion and develop diabetes at a younger age, before neurological abnormalities associated with aceruloplasminaemia are apparent. Therefore, aceruloplasminaemia should be considered in patients with insulin-dependent diabetes mellitus who develop progressive neurological abnormalities of unknown aetiology along with a microcytic hypochromic anaemia and retinal degeneration.
authors.affiliation: Division of Neurology, Jichi Medical School, Kawachi, Tochigi, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Muroi
authors.forename: H
authors.initials: H
authors.lastname: Yagyu
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: M
authors.initials: M
authors.lastname: Nagata
authors.forename: N
authors.initials: N
authors.lastname: Sato
authors.forename: J
authors.initials: J
authors.lastname: Ideno
authors.forename: N
authors.initials: N
authors.lastname: Fujita
authors.forename: A
authors.initials: A
authors.lastname: Ando
authors.forename: K
authors.initials: K
authors.lastname: Okada
authors.forename: Y
authors.initials: Y
authors.lastname: Takiyama
authors.forename: S
authors.initials: S
authors.lastname: Nagasaka
authors.forename: H
authors.initials: H
authors.lastname: Miyajima
authors.forename: I
authors.initials: I
authors.lastname: Nakano
authors.forename: S
authors.initials: S
authors.lastname: Ishibashi
mesh_terms: D001796:Blood Protein Disorders / Q000188:drug therapy* / Q000235:genetics; D002570:Ceruloplasmin / Q000235:genetics / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000235:genetics*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D002570:Ceruloplasmin