Jang Eun Chul, Kim Guilsun, Kim Young Soo, Yoon Sun Ae, Ku Young Mi, Yang Chul Woo, Kim Young Ok
Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
Korean J Intern Med. 2006 Sep;21(3):206-9. doi: 10.3904/kjim.2006.21.3.206.
Hepatic subcapsular steatosis is a rare and specific form of fatty change in the liver. It is a unique finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin causes a unique pattern of fatty infiltration in the subcapsular location of the liver. Here we report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who received intraperitoneal insulin. A 46-year-old diabetic woman on CAPD presented with general weakness. The patient received a total amount of 110 units of regular insulin via intraperitoneal and subcutaneous injection. Her initial blood chemistry showed increased serum lipid and liver enzyme profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We assumed that the cause was CAPD and concomitant intraperitoneal insulin treatment; therefore, the patient was switched from CAPD to hemodialysis (HD) and began to receive insulin subcutaneously. Two months after the beginning of HD, the hepatic subcapsular steatosis completely resolved.
肝包膜下脂肪变性是一种罕见且特殊的肝脏脂肪变化形式。它是接受持续性非卧床腹膜透析（CAPD）和腹腔内胰岛素治疗的糖尿病患者的一种独特表现。腹腔内注射胰岛素会在肝脏包膜下部位引起独特的脂肪浸润模式。在此，我们报告一例接受腹腔内胰岛素治疗的糖尿病CAPD患者发生肝包膜下脂肪变性的病例。一名46岁接受CAPD治疗的糖尿病女性出现全身乏力。该患者通过腹腔内和皮下注射共接受了110单位的正规胰岛素。其初始血液生化检查显示血脂和肝酶水平升高。腹部CT扫描图像和MRI显示出与肝包膜下脂肪变性一致的特征性表现。我们认为病因是CAPD及同时进行的腹腔内胰岛素治疗；因此，将患者从CAPD改为血液透析（HD），并开始皮下注射胰岛素。HD开始两个月后，肝包膜下脂肪变性完全消退。
