Le Minh V, Fourlanos Spiros, Barmanray Rahul D
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.
Department of Medicine, The University of Melbourne, Melbourne, Australia.
Endocrinol Diabetes Metab Case Rep. 2024 Oct 28;2024(4). doi: 10.1530/EDM-23-0145. Print 2024 Oct 1.
Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus (DM) that can theoretically occur in people of any age. While DKA can typically be the first presentation of type 1 DM in younger people, a first presentation is rare in older adults. Pancreatic cancer often manifests with new DM or hyperglycaemia, but very rarely as DKA. We report a case of an 89-year-old woman who was incidentally diagnosed with DKA during workup for an unwitnessed fall. Her DKA was promptly managed, and she was subsequently diagnosed with metastatic pancreatic cancer. Given the advanced stage of her malignancy, the multidisciplinary team consensus was for a palliative approach. She passed away on day 10 of the admission. To our knowledge, this is the first report of a first DKA presentation as a manifestation of pancreatic cancer in an adult aged over 70 years. To date, there is no effective screening test for pancreatic cancer in the general population. However, new-onset DM in the appropriate context might indicate the need for further evaluation. While it is possible that unresectable tumours are identified, earlier diagnosis of DM with pancreatic cancer may facilitate more timely management, including earlier advanced care planning.
A higher clinical suspicion for pancreatic cancer is required for older adults presenting with diabetic ketoacidosis without a previously diagnosed diabetes mellitus. A bi-directional relationship exists between diabetes and pancreatic cancer. Pancreatic cancer generally has a very poor prognosis due to its advanced stage at diagnosis and the lack of an effective screening test. New-onset diabetes in the appropriate context (such as weight loss) can indicate the need for further evaluation for underlying pancreatic cancer.
糖尿病酮症酸中毒（DKA）是糖尿病（DM）的一种并发症，理论上可发生于任何年龄段的人群。虽然DKA通常是年轻人1型糖尿病的首发表现，但在老年人中首次出现这种情况较为罕见。胰腺癌常表现为新发糖尿病或高血糖，但极少表现为DKA。我们报告一例89岁女性病例，她在因未目睹的跌倒进行检查时意外被诊断为DKA。她的DKA得到了及时处理，随后被诊断为转移性胰腺癌。鉴于其恶性肿瘤处于晚期，多学科团队一致认为采取姑息治疗方法。她在入院第10天去世。据我们所知，这是首例70岁以上成年人中首次出现DKA作为胰腺癌表现的报告。迄今为止，普通人群中尚无有效的胰腺癌筛查试验。然而，在适当情况下新发糖尿病可能提示需要进一步评估。虽然可能会发现不可切除的肿瘤，但早期诊断胰腺癌合并的糖尿病可能有助于更及时的管理，包括更早的晚期护理计划。
对于出现糖尿病酮症酸中毒且既往无糖尿病诊断的老年人，需要对胰腺癌有更高的临床怀疑。糖尿病与胰腺癌之间存在双向关系。由于胰腺癌在诊断时处于晚期且缺乏有效的筛查试验，其预后通常很差。在适当情况下（如体重减轻）新发糖尿病可能提示需要对潜在的胰腺癌进行进一步评估。
