Ito Ayako, Kamata Akie, Nozaki Aya, Ando Takao, Kawakami Atsushi
AACE Clin Case Rep. 2019 Apr 25;5(3):e197-e200. doi: 10.4158/ACCR-2018-0418. eCollection 2019 May-Jun.
Exenatide once weekly (ExeOW) is one of the long-acting glucagon-like peptide 1 receptor agonists. Embedding exenatide in poly(D,L-lactide-co-glycolide) microspheres enables the once-weekly subcutaneous injection of exenatide as a treatment for diabetes. We report a case of a patient with type 2 diabetes and hypothyroidism who developed long-standing subcutaneous nodules after treatment by ExeOW injection.
Case report and review of the literature. A 57-year-old Japanese man with type 2 diabetes treated with ExeOW and primary hypothyroidism.
We observed multiple subcutaneous nodules remaining at the ExeOW injection site for >10 weeks. As the patient's thyroid hormone levels normalized, these nodules decreased and disappeared, and his hemoglobin A1c levels improved.
The patient's clinical course suggests that the hydrolysis of ExeOW at the site of injection may be inhibited by concomitant hypothyroidism, in which glycosaminoglycans including hyaluronic acid are known to accumulate (including in the skin). This case may indicate that hypothyroidism prolongs the existence of subcutaneous nodules from ExeOW treatment.
每周一次的艾塞那肽（ExeOW）是长效胰高血糖素样肽1受体激动剂之一。将艾塞那肽包埋于聚（D，L-丙交酯-共-乙交酯）微球中，可实现每周一次皮下注射艾塞那肽来治疗糖尿病。我们报告一例2型糖尿病合并甲状腺功能减退症患者，在接受ExeOW注射治疗后出现长期皮下结节的病例。
病例报告及文献复习。一名57岁日本男性，患有2型糖尿病并接受ExeOW治疗，同时患有原发性甲状腺功能减退症。
我们观察到在ExeOW注射部位有多个皮下结节持续存在超过10周。随着患者甲状腺激素水平恢复正常，这些结节减小并消失，其糖化血红蛋白水平也有所改善。
患者的临床病程提示，注射部位的ExeOW水解可能受到同时存在的甲状腺功能减退症的抑制，已知包括透明质酸在内的糖胺聚糖会在甲状腺功能减退症中蓄积（包括在皮肤中）。该病例可能表明甲状腺功能减退症会延长ExeOW治疗所致皮下结节的存在时间。
