title: Armanni-Ebstein Lesions in Terminal Hyperglycemia.
abstract: Armanni-Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0-77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1-91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β-hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β-hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose.
authors.affiliation: The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, Australia.|Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhou
authors.affiliation: School of Medicine, University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Yool
authors.affiliation: Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.|School of Medicine, University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000473:pathology*; D007662:Ketosis / Q000473:pathology; D007684:Kidney Tubules / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014617:Vacuoles / Q000473:pathology*; D014822:Vitreous Body / Q000378:metabolism; D055815:Young Adult
chemical_list: D005947:Glucose; D020155:3-Hydroxybutyric Acid
keywords: Armanni-Ebstein phenomenon; diabetes mellitus; forensic science; glycogen nephrosis; hyperglycemia; renal tubular vacuolization