THU361 Diabetic Ketoacidosis As The Initial Presentation Of Pancreatic Adenocarcinoma, A Case Report

Abstract

Abstract Disclosure: U. Siddiqui: None. M. Ahmad: None. A. Shaikh: None. D. Rosenberg: None. Introduction: Signs and symptoms of pancreatic adenocarcinoma may be vague early in its course and is often discovered when it has quite advanced. Type 2 diabetes has been known to be linked with pancreatic adenocarcinoma with proposed mechanisms of hyperglycemia in these patients including increased insulin resistance, rapid beta cell turnover and oxidative stress. Rarely, diabetic ketoacidosis has been reported as an initial presentation of pancreatic carcinoma. We describe the case of a 61-year-old male with no previous diabetic history presenting with diabetic ketoacidosis (DKA) and found to have pancreatic adenocarcinoma. Case description: A 61-year-old male with no significant past medical history presented to the emergency department (ED) for a one week history of vision changes, nausea, abdominal pain and non-bloody vomiting. He reported heavy alcohol use on weekends, drinking 12 beers a day. He was found to be in DKA with his lab work demonstrating: venous pH 7.0, glucose 717 mg/dL, bicarbonate 7 mmol/L, anion gap 34 and positive beta hydroxybutyrate >60 mg/dL. After fluid resuscitation and IV insulin infusion he eventually had resolution of his DKA. Anti-GAD 65 screen was negative and c-peptide level was 5.71 ng/ml. His hemoglobin A1C was found to be 12.6. CT abdomen-pelvis with contrast demonstrated a patchy hypodensity of with dilation of pancreatic duct and a 2.0 cm pancreatic mass, resulting in pancreatic duct dilation with an MRI confirming these findings. Endoscopic Ultrasound fine needle aspiration confirmed pancreatic adenocarcinoma. The patient proceeded to have distal pancreatectomy and splenectomy. Surgical samples did not show lymph node involvement. After pancreatectomy the patient did have significantly decreased insulin requirements. Discussion: Pancreatic cancer is often discovered late in its course due to its subtle signs and symptoms. Evidence shows that type 2 diabetes is strongly linked with pancreatic cancer, with newly diagnosed type 2 diabetes or glucose intolerance being found in 80% of patients. Insulin resistance caused by pancreatic cancer has been proposed as an etiology of this new-onset diabetes and hyperglycemia. DKA as an initial manifestation of pancreatic cancer, however, is rare. Through this case we hope to highlight this association and suggest, in the right clinical setting, pancreatic cancer workup be considered in adults presenting with new onset type 2 diabetes and DKA. Presentation: Thursday, June 15, 2023