Alpelisib-Induced Diabetic Ketoacidosis: A Case Report and Review of Literature.
Alpelisib-Induced Diabetic Ketoacidosis: A Case Report and Review of Literature.
复制标题
alpelisib致糖尿病酮症酸中毒1例报告及文献复习。
DOI：
10.1016/j.aace.2020.11.028
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发表时间：
2021-03
影响因子：
--
通讯作者：
Mcgarvey M
中科院分区：
文献类型：
--
作者：
Carrillo M;Rodriguez RM;Walsh CL;Mcgarvey M
报告首例糖尿病酮症酸中毒（DKA）病例及其管理，该患者患有饮食控制的前驱糖尿病和转移性乳腺癌，接受alpelisib（一种PI 3 K（磷脂酰肌醇-3-激酶）抑制剂）治疗。文献的主题进行了审查。该病例是一名66岁女性，患有饮食控制的前驱糖尿病和转移性乳腺癌，在因糖尿病酮症酸中毒入院前2周开始使用alpelisib。入院实验室检查显示血糖为1137 mg/dL，阴离子间隙为25，尿中有大量酮体，血清中丙酮阳性。入院时HbA 1c水平为9.4%（79 mmol/mol），7个月前为6.3%（45 mmol/mol）。患者出院后接受皮下胰岛素治疗，并被告知停用alpelisib。2天后重新开始使用Alpelisib，这在24小时内加重了她的高血糖症。在接下来的几个月里，她的高血糖症通过胰岛素和SGLT 2抑制剂成功控制。不幸的是，她的乳腺癌进展，最终导致停止alpelisib。停用alpelisib后，血糖水平恢复到非糖尿病范围，目前她停用了所有降糖药。尽管PI 3 KCA抑制剂仍然是对既往治疗无反应的转移性乳腺癌患者的一种有前途的药物，但必须密切监测患者的不良反应，如高血糖症。高血压可能是alpelisib的潜在限制性副作用。alpelisib诱导的高血糖症的最佳管理需要进一步研究。
To report the first case of diabetic ketoacidosis (DKA) and its management in a patient with diet-controlled prediabetes and metastatic breast cancer treated with alpelisib, a PI3K (phosphatidylinosiotol-3-kinase) inhibitor. Literature on the topic is reviewed. The case is that of a 66-year-old female with diet-controlled prediabetes and metastatic breast carcinoma who had initiated alpelisib 2 weeks prior to being admitted for diabetic ketoacidosis. Admission laboratory examination revealed a blood sugar of 1137 mg/dL, an anion gap of 25, large ketones in urine, and positive acetone in serum. The HbA1c level was 9.4% (79 mmol/mol) on admission, which had been 6.3% (45 mmol/mol) seven months earlier. She was discharged on subcutaneous insulin and instructed to discontinue alpelisib. Alpelisib was restarted 2 days later, which exacerbated her hyperglycemia within 24 hours. In the following months, her hyperglycemia was successfully managed with insulin and a SGLT 2 inhibitor. Unfortunately, her breast cancer progressed, ultimately leading to discontinuation of alpelisib. Blood sugar levels returned to a nondiabetic range upon discontinuation of alpelisib, and she is currently off all antihyperglycemic agents. Although PI3KCA inhibitors remain a promising drug in patients with metastatic breast cancer who have not responded to previous treatment, patients must be closely monitored for adverse effects such as hyperglycemia. Hyperglycemia could be a potentially limiting side effect of alpelisib. The optimal management of hyperglycemia induced by alpelisib warrants further research.