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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 10.5144/0256-4947.2012.437basm-4-437bCommentsReply to: RE: Glycogen hepatopathy in a 13-year-old male with type 1 diabetes Aljabri Khalid Division of Endocrinology, King Fahad Armed Forces Hospital, Jeddah, Saudi ArabiaJul-Aug 2012 32 4 437 437 Copyright © 2012, Annals of Saudi Medicine2012This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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We thank Prof. Al-Mendalawi for his valuable comments. Glycogen hepatopathy can occur anytime during the duration of diabetes in type 1 diabetes mellitus.

T1DM-associated GH results from excess accumulation of glycogen in hepatocytes, frequently seen in unstable diabetic patients, where hyperglycemia is treated with supra-physiologic doses of insulin. Blood glucose passively enters the hepatocytes in which glycogen synthesis is promoted by high cytoplasmic glucose concentration reliant on the presence of insulin. Glycogen is then trapped within the hepatocytes as a result of a vicious cycle of hyperglycemia and insulin treatment.1,2

Diabetic patients with hepatomegaly and abnormal liver enzymes have often been assumed to have NASH rather than GH. A liver ultrasound is not helpful in distinguishing NASH from GH. Consequently, the condition often goes under-recognized with no further evaluation. GH is a liver condition with minor chance or no risk of progression to fibrosis and is reversible with euglycemic control.1,3
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REFERENCES
1 Munns CF  McCrossin RB  Thomsett MJ  Batch J   Hepatic glycogenosis: reversible hepatomegaly in type 1 diabetes J Paediatr Child Health 2000 36 449 52 11036799 
2 Torbenson M  Chen YY  Brunt E  Cummings OW  Gottfried M  Jakate S    Glycogenic hepatopathy: an underrecognized hepatic complication of diabetes mellitus Am J Surg Pathol 2006 30 508 13 16625098 
3 Chatila R  West AB   Hepatomegaly and abnormal liver tests due to glycogenosis in adults with diabetes Medicine (Baltimore) 1996 75 327 33 8982149