Naccache Deeb D, Nseir William B, Herskovitz Moshe Z, Khamaisi Mogher H
Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, 12 Halia Street, Haifa 3109601, Israel.
J Med Case Rep. 2014 Jan 15;8:20. doi: 10.1186/1752-1947-8-20.
We report a case of the rare entity of diabetic neuropathic cachexia, in order to remind clinicians that these cases still exist.
A 71-year-old Moslem Arab man with type 2 diabetes along with diabetic neuropathic cachexia complicated by a hyperfunctioning autonomous thyroid nodule, and undiagnosed acromegaly came under our care. We report the unique challenges as to what are the priorities to consider in the course of investigation and treatment. This case emphasizes the fast recovery from this remediable disorder, with antineuropathic medication and exogenous insulin to serve as an anabolic hormone on top of its hypoglycemic effect. Shared pathophysiologic aspects of diabetic neuropathic cachexia, cancerous etiologies and acute phase response are discussed.
Diabetic neuropathic cachexia is an integral differential diagnosis, whenever an intense neuropathic pain dominates patient complaints, accompanied with anorexia, weight loss as well as mood and sleep disturbances. This is an original case report of interest to internists, endocrinologists, diabetologists and pain clinic practitioners. Raising the suspicion of diabetic neuropathic cachexia early and concomitant to weight loss investigation, might curtail suffering and prompt early recovery from a severe illness that has a good prognosis.
我们报告一例罕见的糖尿病性神经病变性恶病质病例，以提醒临床医生此类病例仍然存在。
一名71岁的穆斯林阿拉伯男性，患有2型糖尿病以及糖尿病性神经病变性恶病质，并伴有功能亢进的自主性甲状腺结节，且患有未确诊的肢端肥大症，前来我院就诊。我们报告了在调查和治疗过程中需要考虑的优先事项所面临的独特挑战。该病例强调了通过抗神经病变药物和外源性胰岛素，在其降糖作用之外作为一种合成代谢激素，可使这种可治愈疾病快速康复。讨论了糖尿病性神经病变性恶病质、癌症病因和急性期反应的共同病理生理方面。
每当严重的神经病变性疼痛成为患者主诉，同时伴有厌食、体重减轻以及情绪和睡眠障碍时，糖尿病性神经病变性恶病质都是一个不可或缺的鉴别诊断。这是一篇对内科医生、内分泌学家、糖尿病学家和疼痛门诊医生有参考价值的原始病例报告。早期怀疑糖尿病性神经病变性恶病质并同时进行体重减轻调查，可能会减轻痛苦，并促使患者从预后良好的严重疾病中早日康复。
