Abstract Introduction: A 12-year-9-month-old non-Hispanic black male with a history of growth hormone deficiency (GHD), pituitary hypoplasia, pre-diabetes, obesity, hypertension, and hyperlipidemia was initiated on weekly growth hormone (lonapegsomatropin-tcgd) and then transiently developed symptomatic hyperglycemia to 500 mg/dL. We aim to describe this medication effect. Case Presentation: He was born full term and appropriate for gestational age. He was referred to endocrinology at 3.5 years for short stature with a height SDS of -2.48. IGF-1 51.1 ng/mL and IGFBP-3 1.2 ng/mL were low. GH stimulation test noted baseline and peak GH of 0.1 ng/mL. MRI brain showed hypoplastic adenohypophysis, aplastic pituitary stalk, and ectopic neurohypophysis. There had been difficulty with adherence daily GH over the following nine years. BMI trajectory rose to above 180% of the 95th percentile. By age 12, A1c was 6.6%. Metformin was started and increased to 1000 mg twice daily. Subsequent A1c was 6.0%. Due to poor compliance with daily GH, at 12-years-9-months, he was initiated on 22 mg (0.25 mg/kg/week) of weekly lonapegsomatropin-tcgd to improve compliance. The day after his first injection, he developed non-bloody, non-bilious emesis. He denied headaches and endorsed polyuria. Due to concern for increased intracranial pressure, he was sent to the Emergency Department; however, ophthalmologic exam was negative. Initial serum glucose was 500 mg/dL, then 336 mg/dL after one-liter normal saline. Hemoglobin A1c was 5.7%, urine glucose 3+ mg/dL, and urine ketones 2+ mg/dL. Venous pH of 7.379 and bicarbonate of 20.6 mmol/L ruled out diabetic ketoacidosis. Metformin was held during the hospitalization. Hyperglycemia rapidly improved with transient insulin administration. He received one dose of glargine 20 units. He was initiated on lispro carb ratio of 1:8 and correction factor 1:15 for target glucose 150 mg/dL. By day four, glucoses were below 100 mg/dL; lispro was discontinued and he was discharged home. Weekly GH was discontinued with plans to resume daily GH therapy in several months. Conclusion: To conclude, lonapegsomatropin-tcgd offers the convenience of a weekly, rather than daily GH treatment; however, this patient developed a rapid increase in insulin resistance and hyperglycemia requiring insulin. The discrepancy between the glucose of 500 mg/dL and A1c of 5.7%, along with the rapid resolution of hyperglycemia is further consistent with a medication side effect. Close glucose monitoring of patients initiated on weekly growth hormone is crucial, particularly in those with a history of pre-diabetes.


中文翻译：

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每周使用生长激素（氯纳哌马托平）会导致肥胖儿童出现严重短暂性高血糖

摘要 简介：一名 12 岁 9 个月大的非西班牙裔黑人男性，有生长激素缺乏 (GHD)、垂体发育不全、糖尿病前期、肥胖、高血压和高脂血症病史，开始每周注射一次生长激素（lonapegsomatropin） -tcgd），然后短暂出现症状性高血糖至 500 mg/dL。我们的目的是描述这种药物作用。病例介绍： 他足月出生，适合胎龄。他在 3.5 岁时因身材矮小（身高 SDS 为 -2.48）而被转诊至内分泌科。IGF-1 51.1 ng/mL 和 IGFBP-3 1.2 ng/mL 较低。GH 刺激测试显示 GH 基线和峰值为 0.1 ng/mL。脑部 MRI 显示腺垂体发育不全、垂体柄发育不良和神经垂体异位。在接下来的九年里，坚持每日生长激素存在困难。BMI 轨迹升至第 95 个百分位数的 180% 以上。12 岁时，A1c 为 6.6%。开始服用二甲双胍并增加至 1000 mg，每天两次。随后的 A1c 为 6.0%。由于每日 GH 的依从性较差，在 12 岁零 9 个月时，他开始每周服用 22 毫克（0.25 毫克/公斤/周）lonapegsomatropin-tcgd，以提高依从性。第一次注射后的第二天，他出现了非血性、非胆汁性呕吐。他否认头痛并支持多尿。由于担心颅内压增高，他被送往急诊室；然而，眼科检查结果呈阴性。初始血糖为 500 mg/dL，使用 1 升生理盐水后血糖为 336 mg/dL。糖化血红蛋白为 5.7%，尿糖 3+ mg/dL，尿酮 2+ mg/dL。静脉 pH 值为 7.379，碳酸氢盐为 20.6 mmol/L，排除糖尿病酮症酸中毒。住院期间服用二甲双胍。通过短暂注射胰岛素，高血糖迅速改善。他接受了一剂 20 单位的甘精胰岛素。他开始使用 1:8 的赖脯碳水化合物比例和 1:15 的校正因子，目标葡萄糖为 150 mg/dL。到第四天，血糖低于 100 mg/dL；赖脯胰岛素被停用，他出院回家。每周 GH 治疗已停止，并计划在几个月内恢复每日 GH 治疗。结论：总而言之，lonapegsomatropin-tcgd 提供了每周一次而不是每天一次的 GH 治疗的便利性；然而，该患者的胰岛素抵抗迅速增加，并且出现需要胰岛素的高血糖。500 mg/dL 的血糖与 5.7% 的 A1c 之间的差异以及高血糖的快速缓解进一步与药物副作用相符。对每周服用生长激素的患者进行密切血糖监测至关重要，特别是对于有糖尿病前期病史的患者。