RESUMO
Enteropathy-associated T-cell lymphoma (EATL) is a rare but potentially fatal cause of diarrhoea and weight loss. EATL commonly presents with abdominal pain, diarrhoea and weight loss, but can also present with complications such as bowel obstruction and perforation. It is a tumour of intraepithelial lymphocytes that occurs in a relatively young population. It is the most common neoplastic complication of coeliac disease, but can occur with no prior diagnosis of coeliac disease. This case demonstrates the difficulties that can be faced in diagnosing this disorder, particularly when there is no preceding history of coeliac disease. Early diagnosis is of utmost importance in order to start treatment before the effects of malnutrition increase the risk of complications from chemotherapy. Hence awareness of the condition among general medical physicians, to whom it will often present first, is essential. However, even with prompt diagnosis, outcomes for this condition remain poor.
Assuntos
Linfoma de Células T Associado a Enteropatia/complicações , Perfuração Intestinal/etiologia , Linfoma não Hodgkin/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ascite/etiologia , Diarreia/etiologia , Linfoma de Células T Associado a Enteropatia/tratamento farmacológico , Linfoma de Células T Associado a Enteropatia/patologia , Evolução Fatal , Humanos , Intestino Delgado , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Redução de PesoRESUMO
There is increasing use of tyrosine kinase inhibitors as targeted therapy for several malignancies. Sunitinib is the first-line treatment for renal cancer and we report a case of a man receiving this medication who also had diabetes. When started on sunitinib he experienced improvement in his diabetes control with reduction in his insulin requirements, which later worsened when sunitinib was reduced or stopped. Several retrospective studies have been performed demonstrating this effect with sunitinib, but to date no prospective studies have been reported. Most tyrosine kinase inhibitors reduce blood glucose levels in diabetics, but some agents, such as nilotinib, may increase them. There is no consensus on the mechanism of action of sunitinib in reducing glucose levels. Several theories have been postulated, such as increased insulin secretion, increased insulin sensitivity, reduced loss of islet cells, the gastrointestinal side effects of sunitinib, or an interaction with other antihyperglycaemic agents.
