Resolution of insulin-requiring diabetes in a liver transplant recipient after treatment of a pheochromocytoma: case report and review of literature.
The aim of this paper was to report the case of type 2 diabetes and significant insulin resistance that improved dramatically after removal of a pheochromocytoma in a liver transplant recipient , and to provide a review of the relevant literature. We describe the clinical presentation, diagnostic results and management of the patient. In addition, we performed a PubMed search for related English language articles, to provide an overview of the pertinent literature. A 53 year old woman with a history of an orthotopic liver transplantation and insulin-requiring type 2 diabetes was admitted to the hospital with fever, diaphoresis, tachycardia and hypertension. A pheochromocytoma was diagnosed and removed. The patient subsequently developed hypoglycemia and required no further insulin therapy. Pheochromocytomas have been described to lead to hyperglycemia and diabetes, due to the suppression of insulin release and increased insulin resistance. Furthermore, a review of the literature revealed only 3 other reported cases of pheochromocytomas in organ transplant recipients. None of these pheochromocytomas were believed to have occurred de novo after transplantation. This is the first report of a pheochromocytoma in a liver transplant recipient and possibly the first case of a de novo pheochromocytoma in any organ transplant recipient. Moreover, this case showcases pheochromocytomas as a rare cause of diabetes mellitus.
Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine, Mount Sinai Medical Center, New York, NY 10029, USA. Gallagher@mssm.edu
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D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005913:Glipizide / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008108:Liver Diseases, Alcoholic / Q000601:surgery; D016031:Liver Transplantation; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D012074:Remission Induction; D013610:Tachycardia / Q000209:etiology; D016559:Tacrolimus / Q000009:adverse effects
D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; D016559:Tacrolimus; D005913:Glipizide