title: Methylmalonic acidemia and hyperglycemia: an unusual association.
abstract: BACKGROUND
  Hyperglycemia is an exceptional manifestation of methylmalonic acidemia (MMA). We describe a patient with MMA in whom we observed a hyperglycemia which improved under treatment of the metabolic crisis.
  
  
  METHODS
  A 14 month-old boy presented with an acute generalized dystonia and lethargy preceded by fever, vomiting and lethargy at the age of 13 months. Biological investigations showed a hyperglycemia, a lactic acidosis and a hyperammonemia. Urinary organic acid analysis showed accumulation of methylmalonic acid, tiglylglycine and methylcitrate leading to the diagnosis of MMA. The patient underwent symptomatic treatment with rapid improvement of general condition, consciousness and gradual normalization of biological parameters especially glycemia after 6 days without using insulinotherapy.
  
  
  CONCLUSIONS
  MMA is an autosomal recessive disorder caused by a deficiency of methylmalonyl-CoA mutase resulting in methylmalonic acid accumulation. Biochemically, the disorder is typically characterized by: metabolic acidosis, ketonemia or ketonuria, hyperammonemia, leukopenia, thrombocytopenia and anemia. Hypoglycemia is a frequent manifestation of MMA. Our patient presented a hyperglycemia, which is unusual in MMA, since we found only three patients reported with this association. Pathophysiology remains unknown. In reported cases, hyperglycemia was treated by insulin therapy and reducing glucose intravenous infusion, with fatal outcome. In our patient glycemia spontaneously normalized after treatment of the metabolic crisis.
  
  
  CONCLUSIONS
  Hyperglycemia is an exceptional manifestation of MMA and could be a seriousness marker.
authors.affiliation: Department of Child and Adolescent Neurology, UR06/11, National Institute of Neurology, Tunis, Tunisia.
authors.forename: Marouani
authors.initials: M
authors.lastname: Imen
authors.forename: Benrhouma
authors.initials: B
authors.lastname: Hanene
authors.forename: Kraoua
authors.initials: K
authors.lastname: Ichraf
authors.forename: Rouissi
authors.initials: R
authors.lastname: Aida
authors.forename: Turki
authors.initials: T
authors.lastname: Ilhem
authors.forename: Kaabachi
authors.initials: K
authors.lastname: Naziha
authors.forename: Gouider-Khouja
authors.initials: GK
authors.lastname: Neziha
mesh_terms: D000592:Amino Acid Metabolism, Inborn Errors / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004421:Dystonia / Q000209:etiology / Q000628:therapy; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011134:Polysaccharides / Q000627:therapeutic use; D020160:Sodium Benzoate / Q000627:therapeutic use
chemical_list: D011134:Polysaccharides; C008315:maltodextrin; D005947:Glucose; D020160:Sodium Benzoate