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Adrenocorticotropic hormone-secreting pancreatic neuroendocrine carcinoma with multiple organ infections and widespread thrombosis:A case report

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World Journal of Clinical Cases 2022年第17期10卷 5723-5731页

作者： Akihiro Yoshihara Kota Nishihama Chisa Inoue Yuko Okano Kazuhito Eguchi Soichiro Tanaka Kanako Maki Valeria Fridman D'Alessandro Atsuro Takeshita Taro Yasuma Mei Uemura toshinari suzuki Esteban C Gabazza Yutaka Yano Department of Diabetes and Endocrinology Japan Community Health care Organization Yokkaichi Hazu Medical CenterYokkaichi 510-0016MieJapan Department of Diabetes Metabolismand EndocrinologyMie UniversityTsu 514-8507MieJapan Department of Immunology Mie UniversityTsu 514-8507MieJapan Department of Immunology Faculty and Graduate School of MedicineMie UniversityTsu 514-8507MieJapan Department of Immunology and Department of Diabetes Metabolismand EndocrinologyMie UniversityTsu 514-8507MieJapan Department of Immunology Mie University School of MedicineMie UniversityTsu 514-8507MieJapan

BACKGROUND Ectopic adrenocorticotropic hormone(ACTH)-secreting neuroendocrine tumors are rare *** with ACTH-secreting pancreatic neuroendocrine carcinomas have a poor *** and coagulopathies have been reported as the cause of ***,detailed clinical descriptions of the morbid complications of ACTH-secreting neuroendocrine carcinomas have not been *** SUMMARY A 78-year-old Japanese woman consulted a medical center due to systemic edema and epigastric *** analysis revealed hypercortisolemia with increased ACTH secretion without diurnal variation in serum cortisol *** enhanced computed tomography(CT)scan revealed a 3-cm tumor in the pancreatic *** cytological material from endoscopic ultrasound-guided fine-needle aspiration was compatible with ACTHsecreting pancreatic neuroendocrine *** Ki-67 index was 40%.She was transferred to Mie University Hospital for surgical *** patient was diagnosed with urinary tract infection,cytomegalovirus hepatitis,esophageal candidiasis,pulmonary infiltrates suspicious for Pneumocystis carinii pneumonia,peripheral deep vein thrombosis,pulmonary embolism,and disseminated intravascular *** multiple organ infections and thromboses responded well to antimicrobial and anticoagulant *** studies disclosed a pancreatic tumor and a metastatic lesion in the liver,whereas somatostatin receptor scintigraphy showed negative findings,suggesting the primary and metastatic tumors were poorly differentiated.A CT scan before admission showed no metastatic liver lesion,suggesting that the pancreatic tumor was rapidly *** of surgery,antitumor chemotherapy was *** patient was transferred to another hospital to initiate ***,she died four months later due to the rapidly progressive *** ACTH-secreting pancreatic neuroendocrine neoplasm is a rare disease with a very poor ***

关键词： Neuroendocrine tumors Cushing's syndrome Ectopic adrenocorticotropic hormone syndrome Pneumocystis pneumonia Pulmonary embolism Infections Case report

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Sodium-glucose co-transporter-2 inhibitor-associated euglycemic diabetic ketoacidosis that prompted the diagnosis of fulminant type-1 diabetes:A case report

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World Journal of Clinical Cases 2021年第13期9卷 3163-3169页

作者： Taro Yasuma Yuko Okano Soichiro Tanaka Kota Nishihama Kazuhito Eguchi Chisa Inoue Kanako Maki Akihiro Uchida Mei Uemura toshinari suzuki Corina N D'Alessandro-Gabazza Esteban C Gabazza Yutaka Yano Department of Diabetes Metabolismand Endocrinology and ImmunologyMie UniversityTsu 514-8507Japan Department of Diabetes Metabolismand EndocrinologyMie UniversityTsu 514-8507Japan Department of Immunology Mie University School of MedicineMie UniversityTsu 514-8507Japan Department of Immunology Mie University Faculty and Graduate School of MedicineTsu 514-8507Japan Department of Diabetes Mie University Graduate School of MedicineTsu 514-8507Japan

Fulminant type 1 diabetes mellitus(FT1DM)is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of isletβ*** is a very rare disease generally associated with ketoacidosis and the absence of circulating pancreatic islet-related *** ketoacidosis with normal blood glucose levels has been reported during sodiumglucose co-transporter 2(SGLT2)inhibitor *** SUMMARY The patient was a 43-year-old woman that consulted a medical practitioner for malaise,thirst,and *** analysis showed high blood glucose levels(428 mg/dL),a mild increase of hemoglobin A1c(6.6%),and increased ketone bodies in *** patient was diagnosed with type 2 diabetes *** patient was initially treated with insulin,which was subsequently changed to an oral SGLT2 *** to glutamic acid decarboxylase were *** days after receiving oral SGLT2 inhibitor,she consulted at Mie University Hospital,complaining of fatigue and *** analysis revealed diabetic ketoacidosis with almost normal blood glucose *** endogenous insulin secretion was markedly low,and the serum levels of islet-related autoantibodies were *** made the diagnosis of FT1DM with concurrent SGLT2 inhibitor-associated euglycemic diabetic *** patient's general condition improved after therapy with intravenous insulin and withdrawal of oral *** was discharged on day 14 with an indication of multiple daily insulin *** This patient is a rare case of FT1DM that developed SGLT2 inhibitor-associated diabetic ketoacidosis with almost normal blood glucose *** case report underscores the importance of considering the diagnosis of FT1DM in patients with negative circulating autoantibodies and a history of hyperglycemia that subsequently develop euglycemic diabetic ketoacidosis following treatment with a SGLT2 inhibitor.

关键词： Euglycemic diabetic ketoacidosis Sodium-glucose cotransporter 2 inhibitors Fulminant type 1 diabetes Case report

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