Safety and tolerability of diazoxide in Japanese patients with hyperinsulinemic hypoglycemia
Safety and tolerability of diazoxide in Japanese patients with hyperinsulinemic hypoglycemia
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DOI：
10.1507/endocrj.ej15-0428
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发表时间：
2016-03-20
影响因子：
2
通讯作者：
Terauchi, Yasuo
中科院分区：
文献类型：
--
作者：
Komatsu, Yumiko;Nakamura, Akinobu;Terauchi, Yasuo
二氮嗪是一种非利尿的苯并噻二嗪衍生物，是20世纪50年代引入临床实践用于治疗高血压的一组物质之一。Fajans于1979年报道了二氮嗪用于治疗胰岛素瘤。尽管全球范围内高胰岛素血症性低血糖患者接受二氮嗪治疗已超过30年，但最近没有关于该药物在亚洲患者（包括日本患者）中的不良反应的报告。在此，我们报告了6例日本患者（3名女性和3名男性，年龄从58岁到91岁）的回顾性临床记录审查结果，这些患者患有高胰岛素血症性低血糖和不可手术的胰岛素瘤，接受二氮嗪治疗。二氮嗪改善了低血糖症状的控制，6例患者中有5例维持正常血糖，1例无效。令人惊讶的是，尽管所有6名患者都根据西方患者推荐的治疗策略接受了二氮嗪，但6名患者中有5名发生水肿，2名发生充血性心力衰竭。因此，当日本患者开始接受二氮嗪治疗时，应仔细评估液体潴留的症状和体征。此外，应通过在日本高胰岛素血症性低血糖患者中进行的临床试验评价二氮嗪治疗的适当方案。
Diazoxide is a non-diuretic benzothiadiazine derivative, one of a group of substances introduced into clinical practice in the 1950s for the treatment of hypertension. Fajans reported the use of diazoxide for the treatment of insulinoma in 1979. Although patients with hyperinsulinemic hypoglycemia worldwide have been treated with diazoxide for more than 30 years, there are no recent reports about the adverse effects of this drug in Asian patients, including Japanese patients. Herein, we report the results of our retrospective clinical record review of 6 Japanese patients (3 females and 3 males, ranging in age from 58 to 91 years) with hyperinsulinemic hypoglycemia and inoperable insulinoma treated with diazoxide. Diazoxide improved control of hypoglycemic symptoms and maintained normoglycemia in 5 of the 6 patients, and was ineffective in one patient. Surprisingly, although all 6 patients received diazoxide according to the treatment strategy recommended in Western patients, 5 of the 6 patients developed edema and two developed congestive heart failure. Thus, when starting treatment with diazoxide in Japanese patients, the symptoms and signs of fluid retention should be evaluated carefully. Also, appropriate protocols for treatment with diazoxide should be evaluated by means of clinical trials in Japanese patients with hyperinsulinemic hypoglycemia.