Unusual case of pheochromocytoma presenting with diabetic ketoacidosis

Sedhai, Yub Raj; Reddy, Kruthika; Patel, Dhruvan; Lozada, James

doi:10.1136/bcr-2016-216961

Cited by 4 publications

(2 citation statements)

References 20 publications

(21 reference statements)

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“…If studies are included where the presence of diabetes mellitus was not actively tested, the prevalence was lower (15-18 %) [7,15,16]. Although the correlation of PPGL with diabetes mellitus has been established for some time, the unawareness/underestimation of PPGL as a secondary cause of diabetes mellitus has been documented by several published case reports of long-term therapy-resistant diabetes mellitus and newly diagnosed diabetes mellitus with ketoacidosis or hyperglycaemia syndrome, in which the diagnosis of PPGL was only made later and rather incidentally [17][18][19][20][21][22][23][24][25]. Notably, in only rare instances, diabetes mellitus had been the sole clinical manifestation of PPGLs in those patients [26,27].…”

Section: Ppgl and Glucose Homeostasismentioning

confidence: 99%

Metabolic Alterations in Patients with Pheochromocytoma

Erlic

Beuschlein

2018

Exp Clin Endocrinol Diabetes

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Metabolic alterations in patients with hormonally active pheochromocytoma/paraganglioma (PPGL) have been described early on in the literature. The initial findings were related to disturbed glucose homeostasis and lipolysis activation, as well as elevated metabolic rates in affected patients. Similarly, from early autopsy reports, the presence of brown adipose tissue had been noted in PPGL patients. In more recent years, changes in body weight, fat mass and distribution have been analyzed in more detail in addition to activity of brown adipose tissue based on functional imaging techniques. Over the last decades, several larger case series and cohort studies have contributed towards the elucidation of possible mechanism contributing to these clinical observations. Herein, we summarize the clinical and experimental data regarding metabolic alterations and related clinical manifestations in PPGL patients.

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Section: Ppgl and Glucose Homeostasismentioning

confidence: 99%

Metabolic Alterations in Patients with Pheochromocytoma

Erlic

Beuschlein

2018

Exp Clin Endocrinol Diabetes

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“…Growth hormone excess causes insulin resistance and increased lipolysis. Catecholamine excess results in inhibition of pancreatic insulin release, increased hepatic glucose output and reduced skeletal muscle glucose uptake . Thyrotoxicosis is associated with adrenergic‐driven increase in insulin resistance, increased insulin clearance, reduced skeletal muscle uptake of glucose, increased lipase activity and increased glycogenolysis …”

Section: Methodsmentioning

confidence: 99%

Review article: Ketoacidosis in the emergency department

Morton

2020

Emerg Medicine Australasia

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Diabetic ketoacidosis, a life‐threatening complication of type 1 diabetes mellitus, is a common cause of presentation to EDs. Two new drug classes have been found to cause ketoacidosis with distinctive presentations. The sodium‐glucose transport protein 2 inhibitors used in the management of type 2 diabetes mellitus may present with ketoacidosis with normal glucose levels. Ketoacidosis with these medications may be prolonged and recur after initial resolution. Checkpoint inhibitors may present with fulminant diabetic ketoacidosis in individuals with previously normal glucose tolerance. Ketoacidosis may also occur as a result of starvation and alcohol excess, as well as a number of rare causes. Other causes of metabolic acidosis with both high and normal anion gap need to be considered in the differential diagnosis of ketoacidosis. Diabetic ketoacidosis may also present with biochemical changes suggestive of myocardial ischaemia and pancreatitis in the absence of these pathologies. The present paper reviews ketone body metabolism, ketone testing and the causes and differential diagnosis of ketoacidosis with particular relevance to emergency medicine.

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Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report

Bachman

Peterson

Burrage

et al. 2021

The Journal of Critical Care Medicine

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Perioperative management of pheochromocytoma in the setting of catecholamine-induced heart failure requires careful consideration of hemodynamic optimization and possible mechanical circulatory support. A Jehovah’s Witness patient with catecholamine-induced acutely decompensated heart failure required dependable afterload reduction for a cardio-protective strategy. This was emphasized due to the relative contraindication to perioperative anticoagulation required for mechanical circulatory support. A phenylephrine challenge clearly demonstrated adequate alpha blockade after only 24 hours of phenoxybenzamine treatment. This resulted in advancement of the surgery date. This case also highlights management of beta blockade, volume and salt loading, autologous blood transfusion, and profound post-operative vasoplegia in the setting of cardiogenic shock. Careful attention to hemodynamic optimization and cardio-protective strategies ultimately resulted in positive outcome for this challenging clinical scenario.

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Unusual case of pheochromocytoma presenting with diabetic ketoacidosis

Cited by 4 publications

References 20 publications

Metabolic Alterations in Patients with Pheochromocytoma

Metabolic Alterations in Patients with Pheochromocytoma

Review article: Ketoacidosis in the emergency department

Pheochromocytoma, Fulminant Heart Failure, and a Phenylephrine Challenge. The Perioperative Management of Adrenalectomy in a Jehovah’s Witness Patient: A Case Report

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