Subclinical thiamine deficiency identified by preoperative evaluation in an ovarian cancer patient: Diagnosis and the need for preoperative thiamine measurement
Subclinical thiamine deficiency identified by preoperative evaluation in an ovarian cancer patient: Diagnosis and the need for preoperative thiamine measurement
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DOI：
10.1017/s1478951518000615
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发表时间：
2019-10-01
影响因子：
2.2
通讯作者：
Akechi, Tatsuo
中科院分区：
文献类型：
--
作者：
Onishi, Hideki;Ishida, Mayumi;Akechi, Tatsuo
Objective.虽然硫胺素缺乏症（TD）和韦尼克脑病（WE）在癌症患者中并不罕见，但迄今报道的病例在治疗开始后发生TD和/或WE。我们报告一位癌症病患，在术前精神科检查时，诊断为TD，但没有典型的WE临床症状。一名患有卵巢癌的43岁女性被她的肿瘤科医生转诊到心理肿瘤门诊进行术前精神评估。在转诊之前，她的肿瘤一直在迅速生长。虽然她没有出现谵妄、小脑体征或眼部症状，但我们怀疑她可能因为2个月的食欲不振而出现TD，因为体内硫胺素的储存能力约为18天。TD的诊断是由异常低的血清硫胺素水平支持。癌症治疗师需要意识到，硫胺素缺乏症甚至可能在癌症治疗开始之前发生。在食欲不振超过2周的情况下，特别是如果肿瘤迅速增加，无论是否存在谵妄，都应考虑硫胺素缺乏症。
Objective. Although thiamine deficiency (TD) and Wernicke encephalopathy (WE) are not rare in cancer patients, the cases reported to date developed TD and/or WE after treatment had started.Method. From a series of cancer patients, we report a patient diagnosed with TD without the typical clinical symptoms of WE at the preoperative psychiatric examination.Result. A 43-year-old woman with ovarian cancer was referred by her oncologist to the psycho-oncology outpatient clinic for preoperative psychiatric evaluation. Her tumor had been growing rapidly before the referral. Although she did not develop delirium, cerebellar signs, or eye symptoms, we suspected she might have developed TD because of her 2-month loss of appetite as the storage capacity of thiamine in the body is approximately 18 days. The diagnosis of TD was supported by abnormally low serum thiamine levels.Significance of results. Cancer therapists need to be aware that thiamine deficiency may occur even before the start of cancer treatment. In cases with a loss of appetite of more than 2 weeks' duration, in particular, thiamine deficiency should be considered if the tumor is rapidly increasing, regardless of the presence or absence of delirium.