Successful treatment of sulfonylurea-induced prolonged hypoglycemia with use of octreotide.

OBJECTIVE: To report the successful use of octreotide in the management of prolonged hypoglycemia attributable to therapeutic doses of sulfonylureas. METHODS: We present a case series of 6 patients with sulfonylurea-induced hypoglycemia, along with pertinent serial laboratory data and review of the course of management. RESULTS: Most of our 6 study patients had diabetes mellitus, which had been managed with sulfonylurea therapy. In the context of renal failure or heart failure (or both), severe, prolonged hypoglycemia developed. Intermittent intravenous administration of 50% dextrose did not result in a sustained and adequate response. Continuous intravenous administration of dextrose-containing solutions was contraindicated because of fluid overload as a result of congestive heart failure or renal failure. Administration of octreotide, 50 microg subcutaneously every 8 hours, resulted in a prompt and sustained resolution of the hypoglycemia. In 3 of the 6 study subjects, measurements of insulin and C-peptide levels both before and after treatment confirmed the efficacy of the octreotide therapy. CONCLUSION: Our cases demonstrate that octreotide proves to be an effective treatment intervention for prolonged hypoglycemia caused by therapeutic doses of sulfonylureas. This is the first major report of the safe and effective use of octreotide in the management of sulfonylurea-induced hypoglycemia outside the emergency department setting.

Detection of thyrotropin-receptor messenger ribonucleic acid (mRNA) and thyroglobulin mRNA transcripts in peripheral blood of patients with thyroid disease: sensitive and specific markers for thyroid cancer.

Because thyroid cancer cells express functional TSH receptors (TSHR), TSHR-mRNA in peripheral blood might serve as a tissue-/cancer-specific marker. We measured circulating TSHR-mRNA by RT-PCR in 51 normal controls, 27 patients with benign thyroid disease, 67 patients with treated differentiated thyroid cancer (DTC), and eight patients with newly diagnosed DTC, preoperatively. Results were compared with thyroglobulin (Tg) mRNA and serum Tg levels. TSHR-mRNA signals were not detected in normal controls and in 24 of 27 (89%) patients with benign thyroid disease. All 19 patients with treated DTC with evidence of distant or local disease tested positive for TSHR-mRNA (sensitivity 100%). Among patients with no evidence of disease, TSHR-mRNA was detected in 1 in 48 (specificity 98%). Six of the eight newly diagnosed DTC patients tested preoperatively were positive for TSHR-mRNA. The concordance between TSHR-mRNA and Tg-mRNA and between TSHR-mRNA and serum Tg was 95%. Fourteen patients with DTC (21%) had Tg antibodies, three with local disease (all positive for TSHR-mRNA), and 11 with no evidence of disease (all negative for TSHR-mRNA). Our results indicate that TSHR-mRNA and/or Tg-mRNA in peripheral blood are both equally sensitive and specific markers for monitoring thyroid cancer patients. Their principal value resides in the Tg antibody-positive patients in whom a positive or a negative mRNA value might have indicated or obviated the need for a whole-body scan. Furthermore, the high specificity combined with their ability to predict thyroid cancer preoperatively suggests a potential role in detecting thyroid cancer in patients with thyroid nodules.