Fugere Tyler, Roy Arya Mariam, Makhoul Issam
Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
Hematology and Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, USA.
Cureus. 2021 Nov 5;13(11):e19295. doi: 10.7759/cureus.19295. eCollection 2021 Nov.
Alpelisib is a phosphoinositol-3-kinase alpha catalytic subunit (PIK3CA) inhibitor used in patients with PIK3CA mutated breast cancer. The phosphatidylinositol 3-kinase (PI3K) pathway is responsible for activating protein kinase-B (AKT), and activated AKT promotes translation of glucose transporter 4 and glycogen synthesis in insulin-responsive tissues. Therefore, it is perhaps not surprising that hyperglycemia is the most common side effect of alpelisib, though diabetic ketoacidosis (DKA) appears to be a rare complication. This case describes the unique presentation of a patient with no prior history of diabetes who presented with DKA after starting alpelisib, and returned to euglycemia off of insulin just three days after stopping the drug suggesting that alpelisib can cause DKA in patients who did not previously have diabetes, and that the hyperglycemia is completely reversible upon discontinuation of the PIK3CA inhibitor and consequent restoration of the PI3K/AKT pathway.
阿哌利西布是一种磷酸肌醇-3-激酶α催化亚基（PIK3CA）抑制剂，用于治疗PIK3CA突变的乳腺癌患者。磷脂酰肌醇3-激酶（PI3K）通路负责激活蛋白激酶B（AKT），而激活的AKT可促进胰岛素反应性组织中葡萄糖转运蛋白4的翻译和糖原合成。因此，高血糖是阿哌利西布最常见的副作用或许并不奇怪，尽管糖尿病酮症酸中毒（DKA）似乎是一种罕见的并发症。本病例描述了一名既往无糖尿病病史的患者在开始使用阿哌利西布后出现DKA的独特表现，且在停药仅三天后停用胰岛素血糖就恢复正常，这表明阿哌利西布可导致既往无糖尿病的患者发生DKA，并且在停用PIK3CA抑制剂并随之恢复PI3K/AKT通路后高血糖完全可逆。
