インスリン依存型糖尿病を高齢で発症したⅢA型多腺性自己免疫疾患の1例

Abstract

We report a rare case of insulin-dependent diabetes mellitus (IDDM) with chronic thyroiditis with elderly onset in a 72-year-old woman. Chronic thyroiditis was pointed out when she was 68 years old, and she was admitted to our hbspital because of hyperglycemia following a cold in February of 1998. Laboratory data on admission were as follows : fasting blood glucose, 417 mg/dl ; HbA₁🇨, 11.3% ; and glycoalbumin, 43.1%. High titer of anti-thyroglobulin antibody (60.6 U/ml) and anti-thyroid peroxydase anti- body (over 30.0 U/ml) was observed. Both anti-glutamic acid decarboxylase (GAD) antibody and islet cell antibody (ICA) were negative. She was diagnosed as having IDDM because urinary CPR was 4.1 μg/day, and insulin secretion was not induced with glucagon loading test. She was positive for HLA-A 24 and DR 9 which are typically present in IDDM patients. Polyglandular autoimmune disease is known to be a multiple endocrine gland disorder which is induced by autoimmune pathogenesis. This case is included in type ⅢA polyglandular autoimmune disease. It has been also reported that DR 9 was increased in type ⅢA polyglandular autoimmune disease.