恩福妥单抗韦多汀治疗后新发难治性高血糖合并糖尿病酮症酸中毒一例报告

Ross Heinrich, M. Caldwell
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摘要

引言:一名既往未诊断为糖尿病的患者在接受恩福单抗韦多汀(EV)治疗后,出现糖尿病酮症酸中毒(DKA)和严重的胰岛素抵抗。EV相关的DKA并不常见——仅在少数病例报告中有描述——并且具有未知的病理生理学。该病例的特点是该患者DKA的独特特征,以及糖尿病患者中常见的不寻常的胰岛素抵抗量。临床发现:一名71岁男性,表现为疲劳、口干和口渴加剧。他有肥胖、高血压和侵袭性高级别乳头状尿路上皮癌病史。他的实验室结果与DKA一致。临床过程:患者入院并使用标准化方案进行治疗,以纠正与DKA相关的高渗、低血容量、代谢性酸中毒和高血糖。DKA消退后,患者需要大量的每日胰岛素剂量,每天高达1000单位,持续多日,然后转入口服抗高血糖方案。他的研究包括与1型糖尿病相关的自身抗体的阴性结果和C肽水平的升高,这表明在严重胰岛素抵抗的情况下,胰岛素的内源性产生得以保留。结论:EV在治疗尿路上皮癌方面具有明显的作用,在某些临床情况下显示出生存率的提高。高血糖是一种常见的副作用(14%的患者),DKA是一种罕见且可能致命的后果。有已知危险因素的患者,如肥胖或血红蛋白A1c升高,应在EV治疗期间密切监测高血糖和DKA。
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New Onset, Refractory Hyperglycemia with Diabetic Ketoacidosis After Enfortumab Vedotin Treatment: A Case Report
Introduction: A patient with no prior diagnosis of diabetes presented with diabetic ketoacidosis (DKA) and severe insulin resistance after being treated with enfortumab vedotin (EV). EV-associated DKA is uncommon— described in only a few case reports—and has unknown pathophysiology. This case characterizes the unique features of DKA in this patient and an unusual amount of insulin resistance not typically seen in patients with diabetes. Clinical Findings: A 71-year-old male presented with fatigue, xerostomia, and increased thirst. He had a history of obesity, hypertension, and invasive, high-grade papillary urothelial carcinoma. His laboratory results were consistent with DKA. Clinical Course: The patient was admitted to the hospital and treated using a standardized protocol to correct the hyperosmolality, hypovolemia, metabolic acidosis, and hyperglycemia associated with DKA. After the DKA resolved, the patient needed substantial daily doses of insulin, up to 1000 units per day, for multiple days before being transitioned to an oral antihyperglycemic regimen. His workup included negative results for autoantibodies associated with type 1 diabetes and an elevated C-peptide level, suggesting preserved endogenous production of insulin with severe insulin resistance. Conclusions: EV has a clear role in treating urothelial carcinoma, showing improved survival in certain clinical contexts. Hyperglycemia is a common (14% of patients) side effect, with DKA being a rare and potentially fatal consequence. Patients with known risk factors, such as obesity or elevated hemoglobin A1c, should be closely monitored for hyperglycemia and DKA during EV treatment.
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