Diabetes Mellitus Q 19

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Which of the following causes of Hyperglycaemic Hyperosmolar Non-Ketotic Syndrome (HHNS) is most common?

  

    A. Insulin overdose

    B. Removal of the adrenal gland

    C. Undiagnosed, untreated hyperpituitarism

    D. Undiagnosed, untreated diabetes mellitus

    

    

Correct Answer: D. Undiagnosed, untreated diabetes mellitus

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Undiagnosed, untreated diabetes mellitus is one of the most common causes of HHNS. Hyperosmolar hyperglycemic syndrome (HHS) is a clinical condition that arises from a complication of diabetes mellitus. Type 2 diabetes accounts for about 90% to 95% of diabetes cases. It is most commonly seen in patients with obesity. If diabetes mellitus is well controlled, the chance of developing HHS is minimal.

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Option A: Insulin overdose can cause toxicity by causing hypoglycemia and many additional effects, including arrhythmias, coma, seizures, hypotension, amongst other symptoms. Long-term insulin use may lead to dermal toxicity by causing lipodystrophy.

Option B: Primary adrenal insufficiency occurs after bilateral adrenalectomy. Signs and symptoms are volume depletion, hypotension, hyponatremia, hyperkalemia, fever, abdominal pain. Other consequences of bilateral adrenalectomy include hypercortisolism due to excess ACTH stimulation of residual adrenal tissue, adrenal crisis, and the development of an aggressive corticotropic tumor called Nelson’s syndrome.

Option C: Hyperpituitarism can cause several different conditions. These conditions include Cushing syndrome, gigantism or acromegaly, galactorrhea or prolactinoma, and hyperthyroidism.

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