Shibutani Y, Yokota T
Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital.
Nihon Naibunpi Gakkai Zasshi. 1991 Jan 20;67(1):42-9. doi: 10.1507/endocrine1927.67.1_42.
Prolonged hypoglycemia induced by acetohexamide (AH) in a patient with noninsulin dependent diabetes mellitus accompanied by primary hypothyroidism was presented. A 74-year-old man who had been treated with AH (500mg, daily) for diabetes mellitus since 1973 was admitted to our hospital in Oct. 1988 because of hypoglycemic coma. On admission, the level of blood glucose was 20mg/dl. Continuous intravenous administration of 10 per cent glucose solution led to improvement in the mental state on the second day. However, the level of blood glucose remained between 30 to 45mg/dl for four days after admission. On the fifth day, a fasting blood glucose level finally reached 75mg/dl. In a thyroid function test, the serum levels of thyroid hormone showed the following decreases: T3 68ng/dl, T4 2.8 micrograms/dl, free T4 0.3ng/dl, while basal TSH levels increased to 50.3 microU/ml. Since anti-thyroid microsomal antibody was positive and thyroid 99mTc-pertechnetate uptake was slightly elevated, the hypothyroidism in this patient was considered to be caused by chronic thyroiditis. Urinalysis was positive for protein. In a renal function test, the blood urea nitrogen was 26.7mg/dl and creatinine 1.7mg/dl, and creatinine clearance decreased to 22ml/min. After thyroid function returned to euthyroid, creatinine clearance improved (41 ml/min). To clarify the relationship between hypothyroidism and the metabolism of AH, the serum levels of AH and its metabolite hydroxyhexamide (HH) following oral administration of AH (500mg) were evaluated before and after thyroxine replacement therapy. The blood glucose level before therapy was lower than that after therapy, and hypoglycemic symptoms were observed early in the second and third morning after AH administration.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了一例非胰岛素依赖型糖尿病合并原发性甲状腺功能减退患者因醋磺己脲（AH）导致的长期低血糖症。一名74岁男性，自1973年起接受AH（每日500mg）治疗糖尿病，于1988年10月因低血糖昏迷入院。入院时血糖水平为20mg/dl。持续静脉输注10%葡萄糖溶液使患者第二天精神状态有所改善。然而，入院后四天血糖水平一直维持在30至45mg/dl之间。第五天，空腹血糖水平最终达到75mg/dl。甲状腺功能检查显示甲状腺激素血清水平下降如下：三碘甲状腺原氨酸（T3）68ng/dl，甲状腺素（T4）2.8μg/dl，游离甲状腺素（FT4）0.3ng/dl，而基础促甲状腺激素（TSH）水平升至50.3μU/ml。由于抗甲状腺微粒体抗体阳性且甲状腺99m锝-高锝酸盐摄取略有升高，该患者的甲状腺功能减退被认为是由慢性甲状腺炎引起。尿检蛋白呈阳性。肾功能检查中，血尿素氮为26.7mg/dl，肌酐为1.7mg/dl，肌酐清除率降至22ml/min。甲状腺功能恢复正常后，肌酐清除率有所改善（41ml/min）。为明确甲状腺功能减退与AH代谢之间的关系，在甲状腺素替代治疗前后评估了口服AH（500mg）后AH及其代谢产物羟己脲（HH）的血清水平。治疗前血糖水平低于治疗后，且在服用AH后的第二天和第三天清晨早期出现低血糖症状。（摘要截断于250字）
