J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Case Report

Volume 2, Number 4-5, October 2012, pages 181-186

The Development of Central Pontine Myelinolysis in a Type 1 Diabetic Patient With Anti-Insulin Antibody and Similar Clinical Manifestations to Autoimmune Polyglandular Syndrome

Figures

Figure 1. Abdominal computed tomography showing ascites and findings which suggest the existence of liver cirrhosis such as rough hepatic surface and atrophy.

Figure 2. Changes in blood glucose levels at before breakfast, lunch and dinner, and bedtime by switching from the basal-bolus insulin therapy using insulin glargine to three pre-meal injections of insulin glulisine.

Figure 3. Changes in serum levels of blood urea nitrogen (A), creatinine (B), sodium (C) and potassium (D), and blood glucose (E) before the development of central pontine myelinolysis after the admission.

Figure 4. T2-weighted images of magnetic resonance imaging. Arrows indicate lesion of central pontine myelinolysis.

Table

**Table 1.** Clinical, Immunological, and Endocrinological Characteristics of Our Patient With Similar Clinical Manifestations to Autoimmune Polyglandular Syndrome
Autoantibodies	Titer	Suspected Diseases	Endocrinological Findings and Symptoms
ab: antibody; ANA: antinuclear antibody; GAD: glutamic acid decarboxylase; LKM: liver kidney microsome-1; NR: normal range; T3: triiodothyronine; T4: thyroxine; TG: thyroglobulin; TPO: thyroid peroxidase; TSH: thyroid stimulating hormone; ss-DNA: single-stranded DNA.
Anti-TPO ab	< 10 IU/mL	hypothyroidism	TSH 14.45 µIU/mL
	(NR <16)	(Hashimoto’s disease?)	(NR, 0.54 - 4.26)
			free T3 2.16 pg/mL
Anti-TG ab	9 IU/mL		(NR, 2.39 - 4.06)
	(NR <28)		free T4 0.83 ng/dL
			NR, 0.71 - 1.52)
anti-GAD ab	35.0 U/mL	type 1 diabetes	urinary C-peptide < 0.3 µg/day, plasma glucose 400 - 500 mg/dL
	(NR <1.5)		(NR, 29.2 - 167 µg/day)
		Sarcoidosis	uveitis, subcutaneous nodules (pathological diagnosis)
		Candidiasis	esophageal ulcer and esophagitis with Candida
anti-LKM ab	17 IU/mL	Autoimmune hepatitis	liver cirrhosis
	(NR <17)
anti-ss-DNA IgG	90 AU/mL
	(NR <25)
ANA	160 ×
	(NR < 4×)