Department of Internal Medicine, East Carolina University, Greenville, North Carolina 27834, USA.
Endocr Pract. 2012 Jan-Feb;18(1):e10-3. doi: 10.4158/EP11264.CR.
To report the first postmarketing case of necrotizing pancreatitis in a patient on combination therapy of sitagliptin and exenatide.
We describe the patient's clinical presentation, laboratory test results, imaging, and autopsy findings.
A 76-year-old woman with a history of type 2 diabetes mellitus presented with severe abdominal pain, vomiting, and fever requiring hospital admission. She had been treated with exenatide for 3 years to manage her diabetes mellitus. A few weeks before presentation, sitagliptin was added, presumably to further optimize her glycemic control. Acute pancreatitis was diagnosed during hospital admission. At initial presentation, her serum amylase concentration was 1136 U/L (reference range, 10-130 U/L) and her lipase concentration was greater than 3500 U/L (reference range, 0-75 U/L). In addition, computed tomography of the abdomen and pelvis demonstrated extensive previous cholecystectomy, reported no alcohol consumption, and had a normal lipid profile. Although she had a long-standing history of diabetes mellitus, she had no history of pancreatitis or other risk factors that would have caused her to develop the underlying condition. After initial brief improvement, her symptoms worsened, and despite aggressive care, her clinical state deteriorated and she died. Autopsy findings demonstrated acute necrotizing pancreatitis with complete digestion of the pancreas.
Considering the temporal relationship of her symptoms to the addition of sitagliptin to her existing exenatide regimen, this case strongly suggests a possible causal link between exenatide or sitagliptin (or the combination of the 2 drugs) and the etiology of pancreatitis in this patient.
报告首例沙格列汀与艾塞那肽联合治疗患者发生坏死性胰腺炎的上市后病例。
我们描述了患者的临床表现、实验室检查结果、影像学和尸检结果。
一名 76 岁女性，有 2 型糖尿病病史，因严重腹痛、呕吐和发热需要住院治疗。她曾接受艾塞那肽治疗 3 年以控制糖尿病。在出现症状前的几周，加用沙格列汀，可能是为了进一步优化血糖控制。住院期间诊断为急性胰腺炎。初次就诊时，血清淀粉酶浓度为 1136 U/L（参考范围为 10-130 U/L），脂肪酶浓度大于 3500 U/L（参考范围为 0-75 U/L）。此外，腹部和骨盆的计算机断层扫描显示广泛的既往胆囊切除术，没有饮酒史，血脂谱正常。尽管她有长期的糖尿病病史，但没有胰腺炎或其他导致潜在疾病的危险因素。尽管最初有短暂的改善，但她的症状恶化，尽管进行了积极的治疗，她的病情还是恶化了，最终死亡。尸检结果显示为急性坏死性胰腺炎，胰腺完全消化。
鉴于她的症状与沙格列汀加入她现有的艾塞那肽治疗方案的时间关系，本例强烈提示艾塞那肽或沙格列汀（或这两种药物的联合使用）与该患者胰腺炎的病因之间可能存在因果关系。
