Journal of the Japan Diabetes Society

Subclinical Cushing's syndrome (SCS) is often diagnosed incidentally as an adrenal tumor. A 40-year-old woman presented with diabetic ketoacidosis (DKA). A tumor-like lesion was identified in the left ventricle on echocardiography, and multiple cerebral infarctions were observed on brain magnetic resonance imaging. The possibility of embolism from the left ventricular tumor was considered and the tumor was resected. A pathological examination revealed a thrombus. Additionally, an incidental left adrenal tumor was found on abdominal computed tomography, and further examination led to the diagnosis of SCS. Excessive cortisol levels can induce abnormalities in glucose metabolism and increase blood coagulation. In this case, the patient had SCS and developed DKA because of excessive consumption of soft drinks. Dehydration exacerbated blood coagulation, potentially resulting in the formation of a left ventricular thrombus. This case shows that although SCS is asymptomatic, it can progress to serious conditions, depending on lifestyle factors.

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A 28-year-old woman was admitted to our hospital with impending preterm labor at 25 weeks of gestation. Her blood glucose level was 164 mg/dL, and her HbA1c was 5.5 %. A 75 gOGTT was performed, and she was diagnosed with gestational diabetes mellitus because her blood glucose level was higher than the 3-point standard value. She was also positive for the GAD antibody and was referred to our department for a further examination and treatment. After treatment with insulin therapy, her HbA1c level remained in the 5 % range, and she gave birth to a baby boy at 39 weeks of gestation via normal delivery. She was insulin-free after delivery, and her 75 gOGTT was borderline 6 weeks after delivery; however, 6 months after delivery, she developed slowly progressive type 1 diabetes mellitus (probable). Pregnant women with GAD antibody-positive gestational diabetes mellitus are at high risk of developing type 1 diabetes mellitus in the future, and careful follow-up is required. This is a valuable case in which screening for GAD antibody positivity allowed us to follow the patient with an eye on her risk of developing type 1 diabetes, enabling intervention for early treatment.

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