Diabetic ketoacidosis associated with the pheochromocytoma of youth

Isotani, Haruhiko; Fujimura, Yukari; Furukawa, Koichi; Morita, Kunio

doi:10.1016/s0168-8227(96)01330-7

Cited by 19 publications

(8 citation statements)

References 7 publications

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“…If studies are included where the presence of diabetes mellitus was not actively tested, the prevalence was lower (15-18 %) [7,15,16]. Although the correlation of PPGL with diabetes mellitus has been established for some time, the unawareness/underestimation of PPGL as a secondary cause of diabetes mellitus has been documented by several published case reports of long-term therapy-resistant diabetes mellitus and newly diagnosed diabetes mellitus with ketoacidosis or hyperglycaemia syndrome, in which the diagnosis of PPGL was only made later and rather incidentally [17][18][19][20][21][22][23][24][25]. Notably, in only rare instances, diabetes mellitus had been the sole clinical manifestation of PPGLs in those patients [26,27].…”

Section: Ppgl and Glucose Homeostasismentioning

confidence: 99%

Metabolic Alterations in Patients with Pheochromocytoma

Erlic

Beuschlein

2018

Exp Clin Endocrinol Diabetes

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Metabolic alterations in patients with hormonally active pheochromocytoma/paraganglioma (PPGL) have been described early on in the literature. The initial findings were related to disturbed glucose homeostasis and lipolysis activation, as well as elevated metabolic rates in affected patients. Similarly, from early autopsy reports, the presence of brown adipose tissue had been noted in PPGL patients. In more recent years, changes in body weight, fat mass and distribution have been analyzed in more detail in addition to activity of brown adipose tissue based on functional imaging techniques. Over the last decades, several larger case series and cohort studies have contributed towards the elucidation of possible mechanism contributing to these clinical observations. Herein, we summarize the clinical and experimental data regarding metabolic alterations and related clinical manifestations in PPGL patients.

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Section: Ppgl and Glucose Homeostasismentioning

confidence: 99%

Metabolic Alterations in Patients with Pheochromocytoma

Erlic

Beuschlein

2018

Exp Clin Endocrinol Diabetes

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“…Furthermore, we have found relatively high occurrence (39,3%) of glucose metabolism impairment as well. Although, the effects of catecholamines on insulin secretion and glucose metabolism is well known [31][32][33][34][35][36], there are only few data about long-term effects or association with diabetes mellitus [37][38][39][40]. However, a number of glucose metabolism disorders in this multi centre study could be higher, as some patients joined the group after they had undergone the treatment because of the severity of the disease and without previous proper examination for glucose metabolism disturbances.…”

Section: Discussionmentioning

confidence: 85%

Analysis of pheochromocytomas / paragangliomas from Eastern Slovakia

Felšöci

Lazúrová

Wagnerova³

et al. 2013

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This multi centre observational cohort study gives a view about the occurrence, clinical and laboratory presentation, localization, histological type and genetic background of pheochromocytoma (PHEO) and paraganglioma (PGL) in Eastern Slovakia. It included 28 patients (18 women + 10 men), of which 23 were diagnosed to have PHEO (82,1%) and 7 patients (25%) suffered from PGL with retroperitoneal, inguinal/pelvic and mediastinal distribution. Arterial hypertension was the major symptom present in 86 % with slight dominance of paroxysmal form (58%). In 3 cases (10,7%), the diagnosis was gained after differentiation of adrenal incidentaloma in asymptomatic patients. Five patients (17,8%) were classified to have malignant form of the disease. 9 patients (32,1%) were confirmed to have hereditary form - five of them (17,8%) with familiar medullar thyroid cancer (FMTC) and mutations in RET gene classified as multiple endocrine neoplasia 2A and 4 patients (14,3%) with germline mutations of SDHB gene, respectively. There was found a relatively high occurrence of other co-morbidities: thyroid disease in 20 patients (71,4%), impairment of glucose metabolism in 11 patients (39,3%) and apart from FMTC, 4 patients (14,3%) suffered also from other malignancy. Together with a bigger size of the primary tumor (6,6 cm), higher concentrations of metanephrines and prevalence of extra-adrenal tumors, malignant and hereditary forms, we suppose genetic and environmental factors of Eastern Slovakia may play a role in the etiopathogenesis of the tumors.

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“…When these changes occur simultaneously, the pheochromocytoma crisis can show findings similar to FT1DM-induced DKA. However, DKA induced by pheochromocytoma crisis has been rarely reported [11, 12]. It is possible that this case would have developed DKA if insulin therapy had not been administered.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma presenting with severe hyperglycemia and metabolic acidosis following intra-articular glucocorticoid administration: a case report

et al. 2019

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BackgroundThere are several reports of pheochromocytoma crisis triggered by systemic glucocorticoid administration. However, pheochromocytoma crisis after intra-articular glucocorticoid administration has been rarely reported.Case presentationA 45-year-old Japanese man presented to our hospital with a sudden, severe headache. He had no history of diabetes. He had received an intra-articular injection of betamethasone (2 mg) for joint pain, 2 days prior to his admission. On examination, his blood pressure was 240/126 mmHg and pulse was 120 beats/minute. The possibility of cerebrovascular events was ruled out by imaging studies and lumbar puncture. Blood tests revealed severe hyperglycemia (523 mg/dL) and metabolic acidosis (pH 7.21, anion gap 26.2 mEq/L, lactate 11.75 mmol/L) with a glycosylated hemoglobin level of 5.7%. Although a urine sample could not be obtained, fulminant type 1 diabetes mellitus and diabetic ketoacidosis were suspected based on these findings. However, after the initial treatment for diabetic ketoacidosis, his insulin secretion was found to be normal and the plasma levels of ketones were not elevated. This excluded the possibility of fulminant type 1 diabetes mellitus and diabetic ketoacidosis. Subsequently, a left adrenal gland tumor and elevated levels of serum catecholamine and urinary catecholamine metabolites were detected, while his other hormone levels were normal. Serum catecholamine levels did not decrease following the clonidine test, and a functional scintigraphy using iodine-131 metaiodobenzylguanidine showed strong uptake in the region of the left adrenal gland. Although no signs of pheochromocytoma crisis, such as paroxysmal hyperglycemia and hypertension, had been observed since admission, a pheochromocytoma was diagnosed based on the investigations. After controlling his blood pressure, a left adrenalectomy was performed.ConclusionsThis case illustrates that intra-articular glucocorticoid administration can induce a pheochromocytoma crisis and an increase in hyperglycemia, and that pheochromocytoma crisis can resemble the clinical picture of fulminant type 1 diabetes mellitus owing to severe hyperglycemia with metabolic acidosis and normal glycosylated hemoglobin levels, especially under the influence of glucocorticoid.

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Diabetic ketoacidosis associated with the pheochromocytoma of youth

Cited by 19 publications

References 7 publications

Metabolic Alterations in Patients with Pheochromocytoma

Metabolic Alterations in Patients with Pheochromocytoma

Analysis of pheochromocytomas / paragangliomas from Eastern Slovakia

Pheochromocytoma presenting with severe hyperglycemia and metabolic acidosis following intra-articular glucocorticoid administration: a case report

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