Shah Kajal, Charitou Marina
Division of Endocrinology, Stony Brook University Hospital, Renaissance School of Medicine.
AACE Clin Case Rep. 2022 Jan 29;8(4):148-149. doi: 10.1016/j.aace.2022.01.004. eCollection 2022 Jul-Aug.
BACKGROUND/OBJECTIVE: Teprotumumab, a novel treatment for thyroid eye disease (TED), which blocks the insulin-like growth factor 1 receptor, has been associated with improvement in proptosis and inflammatory ocular symptoms. In the original trials, hyperglycemia was reported in 5% to 12% of patients; however, none required hospitalization. We report a case of hyperglycemic hyperosmolar state after the first infusion of teprotumumab.
A 56-year-old woman with Graves' disease, severe thyroid eye disease, and prediabetes presented with polyuria, polydipsia, nausea, abdominal pain, headache, dizziness, and a fall to the emergency department 3 weeks after her first teprotumumab infusion. She was noted to have serum glucose levels of 939 mg/dL, serum bicarbonate levels of 28 meq/dL, serum osmolality of 324 mOsm/kg, and trace ketones in urine. She was treated with intravenous fluids and insulin with subsequent improvement in clinical status and biochemical profile. She was then discharged on multiple daily injections of insulin.
Hyperglycemia is a known adverse effect of insulin-like growth factor 1 receptor inhibitors like teprotumumab. The incidence of hyperglycemia in the original trials was 5% to 12%. Most cases were mild and resolved with titration of current diabetes medications. No cases of hospitalization due to severe hyperglycemia or hyperglycemic hyperosmolar state have been reported until now.
We intend to highlight the severity of hyperglycemia that could occur with the use of teprotumumab and the need for research to evaluate the true incidence of this condition.
背景/目的：替普罗单抗是一种治疗甲状腺眼病（TED）的新型药物，可阻断胰岛素样生长因子1受体，已被证实与突眼改善及眼部炎症症状减轻相关。在最初的试验中，5%至12%的患者报告出现高血糖；然而，无人需要住院治疗。我们报告一例首次输注替普罗单抗后发生高渗高血糖状态的病例。
一名56岁患有格雷夫斯病、严重甲状腺眼病及糖尿病前期的女性，在首次输注替普罗单抗3周后，因多尿、烦渴、恶心、腹痛、头痛、头晕及跌倒前往急诊科就诊。检查发现其血糖水平为939 mg/dL，血清碳酸氢盐水平为28 meq/dL，血清渗透压为324 mOsm/kg，尿中出现微量酮体。给予静脉补液及胰岛素治疗后，其临床状况及生化指标有所改善。随后出院，需每日多次注射胰岛素。
高血糖是替普罗单抗这类胰岛素样生长因子1受体抑制剂已知的不良反应。最初试验中高血糖的发生率为5%至12%。多数病例症状较轻，通过调整现有糖尿病药物得以缓解。此前尚无因严重高血糖或高渗高血糖状态而住院的病例报告。
我们旨在强调使用替普罗单抗可能出现的高血糖严重程度，以及开展研究评估该病症真实发生率的必要性。
