J. Endocrinol. Invest. 13: 79, 1990

LETTER TO THE EDITOR

Atypical environmental factor in expressing type I (insulin-dependent) diabetes mellitus Sir,

when his glycemic profile improved, he was discharged with a single dose of a mixture of actrapid, monotard and ultralente insulin (2). The reported case, at first sight, seems easily classifiable as type I (insulin-dependent) diabetes mellitus, but some considerations are to be made. Probably the patient was genetically susceptible to develop the illness (even if we were unable to determine HLA-DR antigens), but the environmental factor represented by the mentioned steroids abuse might have contributed to its manifestation. In fact diabetes associated with drug-induced or chemical-induced conditions is a well assessed issue (3), and although diabetes often recedes, after drug withdrawal diabetic condition may sometime persist (4). We cannot prove that it is a case of diabetes secondary to drug abuse, but we can postulate that the phenotipic manifestation of type I diabetes in this patient might have never developed, or that it might have developed later. We can conclude we might be in the presence of a patient with type I diabetes determined by the uncommon environmental factor, represented by anabolic steroids abuse.

A 26-year-old man came to our observation complaining of polyuria, polydipsia, insatiable appetite, blurred vision, weight loss, and showed initial signs of dehydration. He presented a fasting glycemia of 17.2 mmol/I, HbA 1 c of 12.1'%, glycosuria, and ketonuria. For these reasons we were at first oriented at classifying the subject as type I (insulin-dependent) diabetes, and we began an intensive insulin treatment (3 or 4 regular insulin injections a day plus a monotard insulin injection at bedtime) (1). Our initial diagnosis of the patient became very doubtful after listening to his clinical history. In fact the young man at the age of 14 had begun to practise a regular agonistic sport activity. When he was 17, in order to better face the various competitions, he became an anabolic steroid user; every 6 days he took stanazololo depot 50 mg (in total 1 0 vials with a weight gain of 10 kg). During his service in the army he stopped this treatment. When he was 19 he once again began to use the following substances in order to improve his sports performances: stanozolol depot 50 mg every 3 days for 15 days, plus stanozolol 2 mg a tablet 8 times a day. He stopped the said treatment for 1 5 days, and then he took: testosterone enantrate depot 250 mg a vial every 3 days, plus oxandrolone 2.5 mg a tablet 12 times a day, all for 3 months. After this therapeutic cycle, he continued for over a month as follows: testosterone propionate a vial every 3 days, plus Oxandrolone 2.5 mg a tablet 12 times a day, plus formebolone 5 mg a tablet 4 times a day, plus dry thyroid F.U. 50 mg plus lipocaic 100 mg. (Obesaic, Manetti Roberts) a tablet 6 times a day. This therapeutical cycle, which lasted 3 yr, was repeated every 3 months for a total of 3 months a yr. When he came to our observation he said that his fasting glycemia one month before was 5.8 mmol/I. During his hospitalization the patient underwent several 24-h glycemic profiles, and soon his mean glycemia fell to 7.2 ± 1.3 mmol/I (M±SD). Basal and glucagon stimulated Cpeptide were respectively 0.80 and 0.85 ng/ ml (normal values: 1-3 ng/ml). Other routine results (liver, pancreatic and heart echography, lower extremities doppler, fundus oculi, X-ray of the cranium, ECG) were normal, and so was the other lab-check. ICAs resulted negative. After the intensive insulin treatment he was injected with regular plus monotard twice a day, and

A. Quatraro, G. Consoli, A. Minei, and M. Magno Diabetic Clinic, Casa di Cura S. Rita, 74100 Taranto, Italy

A. Ceriel/o, and D. Giugliano

Cattedra di Diabetologia e Dietoterapia, P Faco/ta di Medicina, Universita di Napoli, 80138 Naples, Italy

REFERENCES 1. Quatraro A, Consoli G., Minei A, Ceriello A, Giugliano D.

Aggiornamenti in tema di terapia insulinica. Boll. Acc. Med. Pistoiese 54: 109, 1985. 2. Quatraro A 100M treatment with single dose of mixture of three kinds of insulin: 2-yr follow up. Diabetes Care 10: 379, 1987. 3. WHO Technical Report Series, N° 646, 1980 (WHO Expert Committee on Diabetes Mellitus: second report). 4. Marigo S. Diabete secondario. In: Introzzi P. (Ed.), Trattato Italiano di Medicina Interna, parte Nona. Malattie del ricambio e della nutrizione. ed.

3.

USES, Firenze, 1986, p. 873.

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Atypical environmental factor in expressing type I (insulin-dependent) diabetes mellitus.

J. Endocrinol. Invest. 13: 79, 1990 LETTER TO THE EDITOR Atypical environmental factor in expressing type I (insulin-dependent) diabetes mellitus Si...
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