Introduction

Severe and prolonged hypoglycemia can be life-threatening. Therapy and prognosis depend on the underlying causes.

Objectives

To approach hypoglycemic episodes and diagnose glycogen storage disease (GSD).

Methods

A 13-year-old, neutered female, Shih Tzu dog was presented with anorexia, weakness, and diarrhea. Physical examination found abdominal pain and no detectable of neurologic deficit. Pancreatitis was confirmed with abnormal level of SNAP cPL®. Although pancreatitis was resolved, the dog remained chronic, marked fasting hypoglycemia (<25 mg/dl).

Results

To elucidate the cause of hypoglycemia, blood work, and imaging techniques were conducted. Only mild hypoalbuminemia and moderate increased in liver enzymes were found. Cortisol level was normal. Serum insulin concentration was appropriate for the blood glucose concentration. Pre- and post-prandial bile acids were markedly increased. Ultrasonography and CT scan demonstrated focal thickening of gastric wall and heterogenous parenchyma of liver, and heterogenous parenchyma of enlarged pancreas without mass effect in brain respectively. Histology of gastric, pancreatic, and liver samples obtained from exploratory laparotomy revealed gastric amyloidosis, lymphoplasmacytic gastritis, pancreatic hyperplasia, and significant glycogen accumulation in hepatocytes without evidence of other hepatic lesions. Special staining of liver confirmed GSD. The treatments were symptomatic treatment and frequent meals. The dog died after three years of diagnosis. Post-mortem examination was not allowed.

Conclusions

The case showed GSD is the cause of repeated hypoglycemic episodes that definitive diagnosed by histopathology. The disorder is clinically heterogeneous and progressive, and there is no effective treatment. Further study is required to improve our understanding of the disease progression and allow opportunities to investigate treatment interventions.