Superior Mesenteric Artery Syndrome Complicated by Diabetic Ketoacidosis and Graves' Disease in Slowly Progressive Insulin Dependent Diabetes Mellitus (SPIDDM): A Case Report and a Review of the Literature

Abstract

A 48-year-old woman with a history of diabetes was admitted for nausea and vomiting with body weight loss. A blood examination revealed high plasma glucose and thyroid hormone levels and metabolic acidosis. She was therefore diagnosed with both diabetic ketoacidosis (DKA) and hyperthyroidism. Nausea and vomiting continued intermittently despite the administration of saline and insulin. The patient was further diagnosed with superior mesenteric artery syndrome (SMAS) after abdominal computed tomography revealed that a horizontal portion of the duodenum was sandwiched between the aorta and the superior mesenteric artery. Clinicians should be vigilant for SMAS in patients with both DKA and hyperthyroidism who present body weight loss.

Superior Mesenteric Artery Syndrome Accompanied by Acute-onset Type 1 Diabetes Complicated with Graves' Disease

“…To date, six cases of SMAS associated with diabetes (three reports of type 1 diabetes and two reports of type 2 diabetes) have been reported (Table 2) (9,(25)(26)(27)(28). Of note, a recently reported case of SMAS in a diabetic patient from weight loss due to SGLT2 inhibitors implied that body weight loss is a pivotal aspect for this pathology (28).…”

“…Given that both diabetes and Graves' disease induce wasting among those affected by these disorders, a combination of these diseases can precipitate SMAS. However, there have only been a few studies concerning the incidence of SMAS due to diabetes and Graves' disease ( 8 , 9 ). More importantly, such studies have shown that SMAS usually occurs after a long duration of diabetes.…”