Glycogenic hepatopathy - An underrecognised cause of transaminitis in primary care settings: A case report

Glycogenic hepatopathy (GH) is a rare but reversible hepatic condition associated with poorly controlled type 1 diabetes mellitus (T1DM). It results from excessive glycogen accumulation in hepatocytes, leading to hepatomegaly and elevated liver enzyme levels. We report the case of a 28-year-old man with T1DM who presented to a primary care clinic with persistent transaminitis despite discontinuation of potential hepatotoxic agents. Extensive investigations were conducted to exclude common liver pathologies, all of which returned negative. His condition improved following the intensification of insulin therapy and improvement of glycaemic control. This case underscores the role of family physicians in recognising GH as a differential diagnosis in patients with diabetes mellitus with unexplained liver enzyme abnormalities. It also highlights the importance of timely interventions to prevent unnecessary invasive investigations. Early recognition and appropriate glycaemic management in primary care can reverse the condition and minimise the need for extensive testing.