Diabetes as an Initial Presentation of Intraductal Papillary Mucinous Neoplasm.

This is a case of an older man with no prior history of diabetes presenting with a combination of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in the setting of new-onset diabetes mellitus. His further work-up revealed intraductal papillary mucinous neoplasm (IPMN) on pancreatic imaging. Though his diabetes etiology could be multifactorial, it is possible that it is an initial presentation of IPMN. Data have been suggestive of diabetes mellitus associated with degree of dysplasia and worse prognosis of IPMN but the exact pathophysiology behind this is unknown, and it is unclear whether diabetes mellitus is an early presentation of IPMN. We discuss possible differential diagnoses needed to evaluate patients for possible triggers behind DKA and etiologies behind new-onset diabetes mellitus when indicated.