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, 58 (23), 3427-3431

Dramatic Improvement of Glycemic Control by Promptly Starting Steroid Therapy at an Early Stage of Autoimmune Pancreatitis in a Subject With Type 2 Diabetes


Dramatic Improvement of Glycemic Control by Promptly Starting Steroid Therapy at an Early Stage of Autoimmune Pancreatitis in a Subject With Type 2 Diabetes

Shintaro Irie et al. Intern Med.


Glucocorticoid therapy is effective for treating autoimmune pancreatitis, but autoimmune pancreatitis itself and steroid therapy aggravate glycemic control. A 77-year-old man with type 2 diabetes was consulted due to aggravation of glycemic control. He was diagnosed with autoimmune pancreatitis. We promptly started glucocorticoid therapy for autoimmune pancreatitis and insulin therapy for glycemic control. Subsequently, both pancreatitis and diabetes were markedly ameliorated. After stopping glucocorticoid therapy, good glycemic control continued with diet therapy alone. Starting glucocorticoid therapy at an early stage of autoimmune pancreatitis is very important for preserving the insulin secretory capacity and improving glycemic control.

Keywords: autoimmune pancreatitis; insulin secretory capacity; steroid therapy.

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).


Figure 1.
Figure 1.
Abdominal computed tomography obtained five months before the patient’s presentation showed a normal pancreas. Enhanced abdominal computed tomography showed irregular narrowing and enlargement of the main pancreatic duct and a low-density area (red triangle) in the pancreatic body, which showed low intensity in the early phase and enhancement in the late phase.
Figure 2.
Figure 2.
Endoscopic retrograde cholangiopancreatography showed the irregular narrowing (red arrow) and enlargement of the main pancreatic duct. Immunohistochemical staining of the biopsy specimens from the pancreas revealed abundant IgG4-positive plasma cell infiltration, with over 40% of the observed area occupied by such infiltration.
Figure 3.
Figure 3.
The clinical time course. Increased HbA1c levels were observed on admission. After admission, we started insulin therapy instead of oral anti-diabetic agents. In addition, after the diagnosis of autoimmune pancreatitis was made, we started glucocorticoid therapy. The pancreatitis markers and IgG4 levels subsequently decreased. We tapered the prednisolone dose and finally stopped steroid therapy about four months later. Since the glycemic control had also been markedly ameliorated, we stopped insulin therapy about four months later as well and continued only diet therapy. PSL: prednisolone, HbA1c: hemoglobin A1c, GA: glycoalbumin

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