Gapp Jonathan, Anwar Muhammad Fazeel, Parekh Jai, Griffin Timothy
Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA.
Department of Internal Medicine, VA Omaha Medical Center, Omaha, NE, USA.
Intractable Rare Dis Res. 2018 May;7(2):134-137. doi: 10.5582/irdr.2018.01034.
A 61-year-old male was admitted from the outpatient setting for treatment of severe hyperglycemia. Five months earlier, his hemoglobin A1c had been 5 mmol/mol. At presentation, hemoglobin A1c was 11.3 mmol/mol and he required insulin therapy at discharge. Later magnetic resonance imaging (MRI) identified bilateral renal masses, previously seen on ultrasound during workup for chronic kidney disease, as being suspicious for renal cell carcinoma (RCC). He underwent partial nephrectomy and cryoablation with pathology showing papillary type RCC. Hyperglycemia resolved after resection and insulin therapy was discontinued, requiring only an oral hypoglycemic. Hyperglycemia as a paraneoplastic syndrome related to RCC is rare. The cause of this acute hyperglycemia is not understood, though previously suggested mechanisms include ectopic glucagon production, autoimmune causes and interleukin-6 (IL-6) mediated pathways. Severe, new-onset hyperglycemia in the absence of common causes and with a renal mass on imaging may represent an uncommon paraneoplastic syndrome secondary to RCC.
一名61岁男性因严重高血糖从门诊入院接受治疗。五个月前，他的糖化血红蛋白为5 mmol/mol。就诊时，糖化血红蛋白为11.3 mmol/mol，出院时需要胰岛素治疗。后来的磁共振成像（MRI）检查发现双侧肾脏肿块，这在之前慢性肾病检查的超声检查中就已发现，怀疑为肾细胞癌（RCC）。他接受了部分肾切除术和冷冻消融术，病理显示为乳头状肾细胞癌。切除术后高血糖得到缓解，胰岛素治疗停止，仅需口服降糖药。高血糖作为与肾细胞癌相关的副肿瘤综合征较为罕见。尽管之前提出的机制包括异位胰高血糖素产生、自身免疫原因和白细胞介素-6（IL-6）介导的途径，但这种急性高血糖的病因尚不清楚。在没有常见病因且影像学检查发现肾脏肿块的情况下出现严重的新发高血糖，可能代表一种继发于肾细胞癌的罕见副肿瘤综合征。
