Sontag Isabel, Bergmann Laura, Adamek Henning Ernst
Zentrale Notfallambulanz, Klinikum Leverkusen, Academic Hospital of the University of Cologne, Am Gesundheitspark 11, D-51375 Leverkusen, Germany.
Med. Klinik 2, Klinikum Leverkusen, Academic Hospital of the University of Cologne, Am Gesundheitspark 11, D-51375 Leverkusen, Germany.
JCEM Case Rep. 2024 Jan 5;2(1):luad172. doi: 10.1210/jcemcr/luad172. eCollection 2024 Jan.
The efficacy and safety of zanubrutinib, a highly selective next-generation Bruton's tyrosine kinase (BTK) inhibitor, in chronic lymphocytic leukemia and lymphoplasmocytoides immunocytoma seems favorable. Adverse events comprise neutropenia, thrombocytopenia, infection, anemia, and atrial fibrillation. This report describes a 75-year-old man suffering from polydipsia, polyuria, and blurred vision for 10 days. He was diagnosed with lymphoplasmocytoides immunocytoma in 2003. After various therapies, he was started on zanubrutinib in October 2022. A diagnosis of diabetes mellitus had never been established before. On arrival in the emergency department, his plasma glucose was 37.2 mmol/L (671 mg/dL) and glycated hemoglobin (HbA1c) was 14.2%. Circulating antibodies showed positivity for glutamic acid decarboxylase (GAD-65), and his C-peptide level was 1.3 nmol/L (normal range, 0.37-1.47 nmol/L), equivalent to 3.9 ng/mL (normal range 1.1-5.0 ng/mL). From the patient's medical history, it became obvious that the metabolic situation had been problematic for many years, and that diabetes could have been taken into account at least in the summer of 2020 when HbA1c was 6.7%. In patients on tyrosine kinase inhibitors, careful assessment of glycemic control (monitoring HbA1c and blood glucose levels periodically even for nondiabetic patients) is recommended to prevent a major diabetic emergency.
高度选择性的新一代布鲁顿酪氨酸激酶（BTK）抑制剂泽布替尼在慢性淋巴细胞白血病和淋巴浆细胞样免疫细胞瘤中的疗效和安全性似乎良好。不良事件包括中性粒细胞减少、血小板减少、感染、贫血和心房颤动。本报告描述了一名75岁男性，出现烦渴、多尿和视力模糊10天。他于2003年被诊断为淋巴浆细胞样免疫细胞瘤。经过各种治疗后，他于2022年10月开始服用泽布替尼。此前从未确诊过糖尿病。到达急诊科时，他的血浆葡萄糖为37.2 mmol/L（671 mg/dL），糖化血红蛋白（HbA1c）为14.2%。循环抗体显示谷氨酸脱羧酶（GAD-65）呈阳性，他的C肽水平为1.3 nmol/L（正常范围为0.37-1.47 nmol/L），相当于3.9 ng/mL（正常范围为1.1-5.0 ng/mL）。从患者的病史来看，很明显代谢情况多年来一直存在问题，至少在2020年夏天HbA1c为6.7%时就应该考虑到糖尿病。对于服用酪氨酸激酶抑制剂的患者，建议仔细评估血糖控制情况（即使是非糖尿病患者也应定期监测HbA1c和血糖水平），以预防严重的糖尿病急症。
