Endocrine Abstracts

Introduction: Asparaginase is a component of chemotherapy regimens used to treat paediatric acute lymphoblastic leukaemia (ALL). One of its well-known side effects is hyperglycaemia which is probably related to hypoinsulinemia. Its incidence rises significantly when associated with corticotherapy. We present two cases of diabetes related to asparaginase and corticoid administration.

Case 1: Eleven-year-old girl diagnosed with an ALL. Before treatment she had a normal body weight and was normoglycaemic. She started the DFCI-2011 protocol and on the day of the first peg-asparaginase administration she was found to have polydipsia, polyuria and a glycaemia of 700 mg/dl with no clinical evidence of pancreatitis. She started an intensive insulin scheme of therapy with an average dose of 0.6 U/kg/day. On the 16th day insulin dose started to be reduced. Despite the higher doses of corticosteroids in the following asparaginase infusions she needed lower doses of insulin to maintain euglycaemia.

Case 2: Six-year-old boy diagnosed with an ALL at the age of three. He was first treated with DFCI-2005 protocol without evidence of hyperglycaemia. A remission lasting 10 months was achieved with recurrence diagnosed at the age of six. He started the IntReALL-SR-2010 protocol and before this treatment his body weight was between P25-50 and he was normoglycaemic. Seven days after the first peg-asparaginase administration he was found to have a glycaemia of 519 mg/dl with ketonuria of 5 mg/dl, without clinical evidence of pancreatitis. He started an intensive insulin scheme with an average dose of 1.5 U/kg/day. Eleven days after the second peg-asparaginase administration insulin dose started to be reduced and at the end of induction course was stopped. Peg-asparaginase was administered one last time without hyperglycaemia.

Conclusion: Asparaginase-induced hyperglycaemia may cause diabetic ketoacidosis or hyperosmolar hyperglycaemic nonketotic syndrome which can be fatal. It is recommended a frequent assessment of glycaemia in these patients. Its occurrence usually does not lead to suspension of therapy. Hyperglycaemia frequently gets better despite continuous use of asparaginase.