A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma

Objective: We describe a rare case of profound subcutaneous insulin resistance (SIR) presumed due to a paraneoplastic process caused by pancreatic adenocarcinoma that improved with intravenous insulin and tumor resection. Methods: An 80-year-old man with previously well-controlled type 2 diabetes me...

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Autores principales:	Kacey Chae, MD, Jordan Perlman, MD, Ryan B. Fransman, MD, Christopher L. Wolfgang, MD, PhD, Ana De Jesus-Acosta, MD, Nestoras Mathioudakis, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	subcutaneous insulin resistance pancreatic adenocarcinoma paraneoplastic syndrome Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/6f8d0a8eb44945a6a5ece0113c149824
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spelling	oai:doaj.org-article:6f8d0a8eb44945a6a5ece0113c1498242021-11-06T04:32:53ZA Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma2376-060510.1016/j.aace.2021.06.001https://doaj.org/article/6f8d0a8eb44945a6a5ece0113c1498242021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2376060521000705https://doaj.org/toc/2376-0605Objective: We describe a rare case of profound subcutaneous insulin resistance (SIR) presumed due to a paraneoplastic process caused by pancreatic adenocarcinoma that improved with intravenous insulin and tumor resection. Methods: An 80-year-old man with previously well-controlled type 2 diabetes mellitus had worsening glycemic control (hemoglobin A1C increase of 6.5% to 8.6% over 4 months) following a recent diagnosis of pancreatic adenocarcinoma. His blood glucose was uncontrolled at 600 mg/dL despite rapid up-titration of a subcutaneous basal-bolus insulin regimen totaling 1000 units/d. Extensive evaluation of insulin resistance including insulin antibodies and anti-insulin receptor antibodies was negative. Due to clinical deterioration, the patient underwent pancreaticoduodenectomy before the completion of neoadjuvant chemotherapy. The patient received intravenous insulin before surgery, which resulted in rapid improvement in glycemic control. The patient’s blood glucose normalized, and he was maintained on metformin monotherapy following pancreaticoduodenectomy. Results: This patient had evidence of SIR in the setting of pancreatic adenocarcinoma. SIR was likely a paraneoplastic process as glycemic control improved after tumor resection. Interestingly, the patient did not have hyperinsulinemia but rather evidence of β-cell dysfunction, which highlights the possibility of exogenous insulin resistance. Conclusion: Paraneoplastic processes due to pancreatic adenocarcinoma can cause SIR, marked by profound hyperglycemia and deteriorating functional status. It is, therefore important to recognize this rare syndrome and appropriately escalate to a higher level of care and consider proceeding with tumor resection.Kacey Chae, MDJordan Perlman, MDRyan B. Fransman, MDChristopher L. Wolfgang, MD, PhDAna De Jesus-Acosta, MDNestoras Mathioudakis, MDElsevierarticlesubcutaneous insulin resistancepancreatic adenocarcinomaparaneoplastic syndromeDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENAACE Clinical Case Reports, Vol 7, Iss 6, Pp 379-382 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	subcutaneous insulin resistance pancreatic adenocarcinoma paraneoplastic syndrome Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	subcutaneous insulin resistance pancreatic adenocarcinoma paraneoplastic syndrome Diseases of the endocrine glands. Clinical endocrinology RC648-665 Kacey Chae, MD Jordan Perlman, MD Ryan B. Fransman, MD Christopher L. Wolfgang, MD, PhD Ana De Jesus-Acosta, MD Nestoras Mathioudakis, MD A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma
description	Objective: We describe a rare case of profound subcutaneous insulin resistance (SIR) presumed due to a paraneoplastic process caused by pancreatic adenocarcinoma that improved with intravenous insulin and tumor resection. Methods: An 80-year-old man with previously well-controlled type 2 diabetes mellitus had worsening glycemic control (hemoglobin A1C increase of 6.5% to 8.6% over 4 months) following a recent diagnosis of pancreatic adenocarcinoma. His blood glucose was uncontrolled at 600 mg/dL despite rapid up-titration of a subcutaneous basal-bolus insulin regimen totaling 1000 units/d. Extensive evaluation of insulin resistance including insulin antibodies and anti-insulin receptor antibodies was negative. Due to clinical deterioration, the patient underwent pancreaticoduodenectomy before the completion of neoadjuvant chemotherapy. The patient received intravenous insulin before surgery, which resulted in rapid improvement in glycemic control. The patient’s blood glucose normalized, and he was maintained on metformin monotherapy following pancreaticoduodenectomy. Results: This patient had evidence of SIR in the setting of pancreatic adenocarcinoma. SIR was likely a paraneoplastic process as glycemic control improved after tumor resection. Interestingly, the patient did not have hyperinsulinemia but rather evidence of β-cell dysfunction, which highlights the possibility of exogenous insulin resistance. Conclusion: Paraneoplastic processes due to pancreatic adenocarcinoma can cause SIR, marked by profound hyperglycemia and deteriorating functional status. It is, therefore important to recognize this rare syndrome and appropriately escalate to a higher level of care and consider proceeding with tumor resection.
format	article
author	Kacey Chae, MD Jordan Perlman, MD Ryan B. Fransman, MD Christopher L. Wolfgang, MD, PhD Ana De Jesus-Acosta, MD Nestoras Mathioudakis, MD
author_facet	Kacey Chae, MD Jordan Perlman, MD Ryan B. Fransman, MD Christopher L. Wolfgang, MD, PhD Ana De Jesus-Acosta, MD Nestoras Mathioudakis, MD
author_sort	Kacey Chae, MD
title	A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma
title_short	A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma
title_full	A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma
title_fullStr	A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma
title_full_unstemmed	A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma
title_sort	rare case of subcutaneous insulin resistance presumed to be due to paraneoplastic process in pancreatic adenocarcinoma
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6f8d0a8eb44945a6a5ece0113c149824
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A Rare Case of Subcutaneous Insulin Resistance Presumed to be due to Paraneoplastic Process in Pancreatic Adenocarcinoma

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