engleski

Hyperglycaemia in children with cancer: two case reports.

Background: Hyperglycaemia induced by stress of disease or steroid therapy may indicate an early defect in glucose regulation. Hyperglycaemia is known to be a common adverse reaction of steroid therapy in 20% to 50% of nondiabetic patients. In cancer patients, corticosteroids are often prescribed as part of treatment or for symptom management. Aim: We present two cases with hyperglycaemia during chemotherapy: one with corticosteroid-induced hyperglycaemia and the other one with hyperglycaemia induced by stress of chemotherapy. Patients: Case 1, a 12-year-old girl with acute lymphatic leukaemia ; Case 2, a 2-year-old boy with yolk sac testicular tumour. Both children, without a history of diabetes, were treated with chemotherapy at Haematology-Oncology Department, Zagreb Children's Hospital. Corticosteroid therapy was introduced during chemotherapy (2nd cycle) only in Case 1. Results: Case 1: Before corticosteroid therapy, blood glucose was normal (<5 mmol/L). Hyperglycaemia developed after corticosteroid therapy introduction, increasing glucose concentration to up to 16.4 mmol/L, without acidosis. Hyperglycaemia was present throughout the treatment. Treatment without insulin maintained blood glucose at 11 mmol/L or less. Upon completion of corticosteroid therapy and chemotherapy, glucose level returned to the normal range. Case 2: Before and during chemotherapy without corticosteroids, glucose concentration was within the reference range (<5.0 mmol/L). At the end of the 4th chemotherapy cycle, glucose concentration increased to 23.5 mmol/L (repeated after 12 h: 22.8 mmol/L) with ketoacidosis (BE=-17.9). The boy was referred to Endocrinology Department, where type 1 diabetes was verified. Conclusion: Our results point to the necessity of glucose monitoring in cancer patients undergoing chemotherapy, in particular when corticosteroids are introduced in therapy. Corticosteroid induced-hyperglycaemia is transient in most cases (Case 1). In patients with prediabetes, stress and physical effects of chemotherapy can lead to diabetes (Case 2). Glucose monitoring and continuous insulin therapy are recommended at glucose levels >7.8 mmol/L. This approach may prevent inflammation, immunosuppression, and symptoms of hyperglycaemia. Also, it may help recognize previously undiagnosed diabetes.

hyperglicaemia ; chemotherapy ; corticosteroid therapy ; child ; diabetes

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