Ann Pediatr Endocrinol Metab.  2018 Dec;23(4):226-228. 10.6065/apem.2018.23.4.226.

Severe recurrent nocturnal hypoglycemia during chemotherapy with 6-mercaptopurine in a child with acute lymphoblastic leukemia

• Cho EM
• Moon JE
• Lee SJ
• Ko CW

• KMID: 2432275
• DOI: http://doi.org/10.6065/apem.2018.23.4.226

Abstract

Various endocrine dysfunctions occur during chemotherapy, including hypoglycemia. However, reports of hypoglycemia associated with 6-mercaptopurine (6-MP) are rare. Herein, we report an 8-year-old boy with severe symptomatic hypoglycemia likely due to 6-MP during chemotherapy. He had been diagnosed with acute lymphoblastic leukemia 3 years previously and was in the maintenance chemotherapy period. Treatment included oral dexamethasone, methotrexate, and 6-MP, of which only 6-MP was administered daily. Hypoglycemic symptoms appeared mainly at dawn, and his serum glucose dropped to a minimum of 37 mg/dL. Laboratory findings showed nothing specific other than increased serum cortisol, free fatty acids, ketone, alanine aminotransferase, and aspartate aminotransferase. Under the hypothesis of hypoglycemia due to chemotherapy drugs, we changed the time of 6-MP from evening to morning and recommended him to ingest carbohydrate-rich foods before bedtime. Hypoglycemia improved dramatically, and there was no further episode during the remaining maintenance chemotherapy period. To the best of our knowledge, this is the first report of this type of hypoglycemia occurring in an Asian child including Korean.

Keyword

Hypoglycemia; 6-Mercaptopurine; Acute lymphoblastic leukemia; Maintenance chemotherapy

MeSH Terms

6-Mercaptopurine*
Alanine Transaminase
Asian Continental Ancestry Group
Aspartate Aminotransferases
Blood Glucose
Child*
Dexamethasone
Drug Therapy*
Fatty Acids, Nonesterified
Humans
Hydrocortisone
Hypoglycemia*
Maintenance Chemotherapy
Male
Methotrexate
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
6-Mercaptopurine
Alanine Transaminase
Aspartate Aminotransferases
Dexamethasone
Fatty Acids, Nonesterified
Hydrocortisone
Methotrexate

Figure

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  Fig. 1. This figure shows the change in fasting serum glucose level checked early morning during hospitalization. On the 7th day of admission, the dosing time of 6-mercaptopurine (6-MP) was changed to morning, and no further hypoglycemic episodes were observed. After 12 days of admission, oral dexamethasone was started according to the COG AALL 0331 protocol, and fasting serum glucose level showed a sharp increase (horizontal gray line=fasting serum glucose 60). COG, Children's Oncology Group-the world’s largest organization devoted exclusively to pediatric cancer research; AALL0331, protocol for standard risk acute lymphoblastic leukemia.

Reference

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