A huge
hepatomegaly was seen in a 30-yr-old female diabetic who was treated with high dose of
insulin for her uncontrollable food ingestion. The liver function at the peak of the hepatic enlargement showed a moderate increase of
transaminases,
alkaline phosphatase, and
gamma-glutamyl transpeptidase. The histology of the
enlarged liver revealed PAS-positive granules in enlarged hepatocytes, indicating the presence of massive
glycogen storage. On admission, she was maintained under a
calorie-restricted diet and received approximately 15 to 20 units per day of
insulin supplement. At one month after admission, a marked shrinkage of her
enlarged liver and restoration of normal liver function were observed concomitantly with the return of fair control of her
blood sugar levels. One year later, she had an episode of
diabetic ketoacidosis which subsequently was treated with a continuous low-dose infusion of
insulin; however, she showed neither
hepatomegaly nor
liver dysfunction during this episode. There have been 20 cases reported of Japanese diabetics with marked
hepatomegaly, in whom the vigorous treatment of
diabetic ketoacidosis with
insulin seemed to be a trigger of the
enlarged liver. This has occurred mostly in patients with
insulin-dependent diabetes mellitus. We present a case of
non-insulin-dependent diabetes mellitus with
glycogen storage
hepatomegaly, presumably due to excessive
insulin supplements. This suggests that
glycogen storage
hepatomegaly in diabetics may not be only due to an acute restoration from
diabetic ketoacidosis, but may also be due to an overinsulinization in an attempt to maintain a euglycemic condition in spite of excess food intake.