[Diabetes mellitus onset in young patient: type 1 diabetes?].

mptomatic diabetes as a manifestation of another underng condition is uncommon, and usually due to the use drugs with hyperglycemic potential or to neoplastic prosses in the pancreatic area. Among drugs, special mention uld be made of high-dose steroids and, more recently d in young patients, atypical neuroleptics.1 The onset of rdinal symptoms of diabetes mellitus (DM) in a patient der 40 years of age, with no other organ-specific clinical ns or concomitant treatment suggests autoimmune diates (type 1A) as the first diagnostic possibility, while in erly patients it should rule out an underlying neoplastic ndition. We report the case of an apparent onset of type 1 in which subsequent evaluation showed an unexpected, ersible etiological diagnosis. A 38-year-old male patient with unremarkable personal family history was referred from the emergency room hyperglycemia with ketosis. The patient reported uriry frequency and severe polydipsia for the previous three eks, and the loss of 12 kg in the previous year with decreased appetite or other symptoms. The results tests performed in the emergency room showed blood cose 340 mg/dL, ketone bodies in urine 50 mg/dL, and 7.4, weight 56.5 kg (BMI 17 kg/m2), blood pressure 5/95 mmHg, and heart rate 100 beats per minute, with other physical examination findings. Basal-bolus insulin rapy (glargine and aspart) and diabetes education were rted, and good glycemic control was achieved. Glycosyed hemoglobin at onset was 13.4%, with negative anti-IA2 sulinoma antigen 2) and anti-GAD (glutamic acid decarxylase) antibodies, and a basal C-reactive peptide level of ng/mL. Diagnosis of type 1A DM was therefore discarded, d additional tests were performed to rule out secondary uses. Levels of thyroid hormones, cortisol, calcitonin, calm, and phosphorus were normal. Abdominal ultrasound ealed a 7-cm right adrenal mass, which magnetic onance imaging confirmed to be a heterogeneous tumor th a necrotic center (Fig. 1). The results of measurents of catecholamines and their metabolites in 24-h