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Etanercept-induced hypoglycemia: the cure for diabetes?

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RWCS 2017 | Emily Pfeifer, MD

Dr. already kavanagh from rwc s 2017 been a very good meeting and one of the real thrills and really good educational aspects has been the presentations by the fellows we have a number of really good abstracts i’m going to review one of those now hello yeah i’m emily pfeiffer i’m one of the second-year fellows from university of colorado high number and also true in

The case really quick so this was a very interesting case that i had is the first year last year of a 58 year old gentleman who came in to the va down in denver for really significant pain all over he said he was actually admitted for a psych diagnosis of suicidal ideation so it was an interesting situation in that we had him sort of captive in the hospital for three

Months and so we got to monitor him very closely after we started treating him for what turned out to be psoriatic arthritis so he had lots of inflamed join psoriasis all over which was why he was having so much pain so it was nice and that because his suicidal ideation was related to something more than just it’s like yes disorder it was related to something that we

As rheumatologist can actually treat so he had really great sacroiliitis on his imaging for us to see not for him and him he it was very inflamed when we met him but the rest of his laboratory workup was pretty much normal the other interesting twist in his story was that he had hepatitis c which limited what we could do as far as treatment for him and so we ended

Up giving him the tanner clapton some high-dose steroids just because he was so in flames even with the risk of making his psoriasis worse and he did really really well on the inflammation in his joints in his skin everything got better but then as he was an inpatient the nurses on the psych service noted that his blood sugar’s started to drop very significantly

Down into the 30s and 40s he was very symptomatic and so we took off all of the insulin he was on he was on long an active and short acting and then was on metformin as well and we were able to get him off of all of them and he was still having hypoglycemic episodes and they actually seem to correlate with when he got his doses of etanercept so we were actually

Able to watch that if he was an inpatient our endocrinology colleagues helped us do a full workup for other causes of hypoglycemia he had normal insulin levels no insulin antibodies and almost peptide he was eating normally liver function was normal there wasn’t anything to explain it except his enroll is the only thing that we had added to him and so just a very

Brief literature review there are some case reports in case series of tnf inhibitors causing similar hypoglycemic episodes more nobody was quite as severe as this gentleman but this has been recorded and the hypothesis for why this works is the tumor necrosis factor is doing more than just the inflammation in the joints in the skin that we as dermatologists think

About it can cause on insulin resistance and it can promote beta cell apoptosis in the pancreas and so their sugars are just a lot harder to control when they’re so inflamed and so there are a handful of case reports of other medications that we use doing the same thing and so i don’t think it’s difficuit a nerd stuff but it is something interesting to think about

And something to keep in mind when we’re starting these patients on these medications i think he is as a severe kind of example of what can happen but just something very interesting i can write alright well thank you great presentation a very interesting case just reminds us who need to be broad-minded about safety issues this is dr. rd kavanagh from our wcs 2017

Transcribed from video
Etanercept-induced hypoglycemia: the cure for diabetes? By RheumNow