Pulmonary hypertension, heart failure and neutropenia due to diazoxide therapy

Yıldızdaş, Dinçer; Erdem, Sevcan; Küçükosmanoğlu, Osman; Yılmaz, Mustafa; Yüksel, Bilgin

doi:10.1007/s12325-008-0049-3

Cited by 48 publications

(33 citation statements)

References 11 publications

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“…Prevalent complications, such as hypertrichosis, have also been proposed for diazoxide. Serious complications including pulmonary hypertension, heart failure and neutropenia (16), hepatomegaly, severe fluid retention, diffuse edema, congestive heart failure, and respiratory failure requiring mechanical ventilation (17) have also been reported. Another problem that exists in our country is the fact that diazoxide is not always available, due to sanctions.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Soheilipour

Jamshidi

Ahmadi

et al. 2015

Arch. Endocrinol. Metab.

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SUMMARYHyperinsulinemia, diagnosed by laboratory tests, should be diagnosed and treated as soon as possible to prevent fatal complications such as neurological damage. Patients who are resistant to medical therapy should be treated surgically. Minimally invasive surgery, a newly developed approach, is a good choice among surgical procedures to avoid unnecessary extensive pancreatectomy. Here, a 12-year-old boy is presented with diagnosis of hyperinsulinemic hypoglycemia who had recurrent attacks of hypoglycemia and seizures from infancy. Because of his unresponsiveness to medical therapy and his family's preference, he underwent laparoscopic pancreatectomy to reduce morbidity and hospital stay. Two years postsurgical follow-up revealed a normo-glycemic state. Arch Endocrinol Metab. 2015;59(5):466-9

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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Soheilipour

Jamshidi

Ahmadi

et al. 2015

Arch. Endocrinol. Metab.

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“…As a result of the direct toxic effect of this drug, fl uid retention, heart failure, and hypertrophic changes of the pulmonary smooth muscles and myocardium may take place, and pulmonary hypertension may be seen. It i s also known that these effects resolve spontaneously after diazoxide withdrawal (6,7,11,12) . In addition to diazoxide treatment, thiazide diuretics are recommended for the prevention of fl uid retention (1,2) .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension and reopening of the ductus arteriosus in an infant treated with diazoxide

Demirel

Ünal

Çetin

et al. 2011

Journal of Pediatric Endocrinology and Metabolism

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Diazoxide is the main therapeutic agent for persistent hyperinsulinemic hypoglycemia. Generally, it is tolerated well, but rarely it can cause severe life-threatening complications. We report a neonate who was treated with diazoxide for hyperinsulinemic hypoglycemia. On the 6th day of the treatment we observed sepsis-mimicking symptoms, mild pulmonary hypertension, and re-opening of the ductus arteriosus. All these fi ndings resolved dramatically shortly after discontinuation of treatment. To our knowledge, this is the fi rst reported case of re-opening of the ductus arteriosus due to diazoxide toxicity.

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“…Diazoxide is commonly used as first line treatment for CHI. Diazoxide can cause fluid retention1 and cardiovascular adverse events 2. Heart failure in a child with underlying cardiac anomalies has been observed with high doses (15 mg/kg/day) of diazoxide 3.…”

Section: Descriptionmentioning

confidence: 99%

Echocardiography monitoring for diazoxide induced pericardial effusion

Avatapalle

Banerjee²,

Malaiya³

et al. 2012

Case Reports

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DESCRIPTIONA 3-year-old boy with Down's syndrome with no underlying cardiac anomalies presented with hypoglycaemia due to congenital hyperinsulinism (CHI). He received treatment with oral diazoxide (Proglycem) (10 mg/kg/day), along with the diuretic chlorothiazide, which ensured glycaemic stability. However, a large pericardial effusion ( fi gure 1A ) requiring drainage was noted within a month. Diazoxide was discontinued and second line treatment with octreotide was commenced. Despite large doses (30 μg/kg/ day), glycaemic control remained unsatisfactory. A further trial of diazoxide was undertaken, pending a decision for subtotal pancreatectomy. Diazoxide was introduced at 1 mg/kg/day and increased to 4 mg/kg/day (low dose) by 2 weeks with satisfactory glycaemic control. However, serial weekly echocardiography detected minimal pericardial effusion ( fi gure 1B ) without overt features of cardiovascular instability. Withdrawal of diazoxide therapy led to resolution of the pericardial effusion. Euglycaemia was achieved by subtotal pancreatectomy. Diazoxide is commonly used as fi rst line treatment for CHI. Diazoxide can cause fl uid retention 1 and cardiovascular adverse events. 2 Heart failure in a child with underlying cardiac anomalies has been observed with high doses (15 mg/kg/day) of diazoxide. 3 However, it is not recognised that diazoxide in low doses can cause pericardial effusion, particularly in the absence of underlying cardiac anomalies. In this case report, we have observed pericardial effusion at both high and low doses of diazoxide in a child with a structurally normal heart. Therefore, we would recommend meticulous cardiovascular monitoring in children commenced on diazoxide for CHI to prevent serious haemodynamic instability from developing pericardial effusions. Competing interests None. Patient consent

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Pulmonary hypertension, heart failure and neutropenia due to diazoxide therapy

Cited by 48 publications

References 11 publications

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Pulmonary hypertension and reopening of the ductus arteriosus in an infant treated with diazoxide

Echocardiography monitoring for diazoxide induced pericardial effusion

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