Refractory diabetes insipidus leading to diagnosis of type 2 diabetes mellitus and non-ketotic hyperglycemia in an adolescent male.

CASE REPORT An obese 16-year-old male presented with chronic headaches and bitemporal visual field loss. Physical exam showed acanthosis nigricans and BMI of 39.8 kg/m.2 MRI of the brain revealed craniopharyngioma (Figure 1). He developed hypopituitarism after surgery, requiring Hydrocortisone, Levothyroxine, Testosterone enanthate, and desmopressin (DDAVP). Two months later, he presented with uncontrolled polyuria despite increasing DDAVP doses up to 1.7 mg daily. A two-hour post prandial blood glucose was 400 mg/dL and hemoglobin A1C was 10.2%, consistent with diabetes mellitus (DM). Diabetes autoimmune panel was negative. He was started on insulin Glargine and Lispro. Two days after starting insulin, he had a seizure consisting of staring episodes, right upper extremity shaking, right-eye deviation and urinary incontinence. Laboratory exam showed venous pH 7.36, sodium 139 meq/L, bicarbonate 19.3 meq/L, glucose