MON-534 Steroid Therapy Reverses Diabetes In IgG4-related Autoimmune Pancreatitis: A Therapeutic Paradox

Abstract Disclosure: L.K. Modha: None. K.V. Sheth: None. "Steroid Therapy Reverses Diabetes in IgG4-Related Autoimmune Pancreatitis: A Therapeutic Paradox" Autoimmune pancreatitis as a manifestation of IgG4 related diseases can induce Diabetes even with a subtle involvement of pancreas. We report a case of a 23-year-old man who presented with IgG4 cholangiopathy with autoimmune pancreatitis confirmed by ERCP guided biopsy of ampulla showcasing lymphocytic and plasma cell infiltrates in the lamina propria with variable eosinophils and obliterative phlebitis alongside elevated IgG4 levels. He went into remission following Prednisone therapy but relapsed a year later with pancreatitis, cholangitis and new onset Diabetes Mellitus. Insulin therapy initially followed by augmentation with Metformin was instituted to achieve glycemic control. ERCP and stenting was performed for IgG4 cholangiopathy and pancreatitis, following which Prednisone was begun. A steroid induced hyperglycemia was anticipated while keeping a close watch on the blood glucose levels but a surprising outcome unfolded. A paradoxical hypoglycaemia was observed and Insulin doses were deescalated. Over the next few weeks a rapid decline in the Insulin requirements was observed, ultimately culminating in complete discontinuation of Insulin and Metformin. He achieved complete remission of diabetes within 2 months of immunosuppressant therapy with Prednisone and Azathioprine. The case highlights how early initiation of steroid therapy dramatically improves the glycemic control and outweighs the negative effect of steroids on glucose tolerance. Presentation: Monday, July 14, 2025