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Diazoxide-Responsive Hypoglycemia in a Child Receiving Dasatinib for Treatment of B-Cell Acute Lymphoblastic Leukemia

Madalin Berra1, Juliana Biro1, Himala Kashmiri1

  • 1Division of Pediatric Endocrinology, University of California Irvine: Children's Hospital of Orange County, Orange, CA 92868, USA.

JCEM Case Reports
|December 11, 2024
PubMed

Insights

Tyrosine kinase inhibitors (TKIs) can cause hypoglycemia in children with acute lymphoblastic leukemia (ALL). This case study highlights a child treated with dasatinib who developed refractory hypoglycemia, managed with diazoxide.

Area of Science:

  • Pediatric Oncology
  • Endocrinology
  • Pharmacology

Background:

  • Tyrosine kinase inhibitors (TKIs) are increasingly used in pediatric cancer treatment.
  • TKIs have unique side effect profiles, including endocrine-related disorders (endocrinopathies).
  • Understanding TKI-related side effects is crucial for managing pediatric cancer patients.

Observation:

  • A 2-year-old boy with Philadelphia chromosome-like (Ph-like) B-cell acute lymphoblastic leukemia (ALL) was treated with dasatinib.
  • The patient developed severe, persistent hypoglycemia (low blood sugar).
  • Clinical evaluation suggested hyperinsulinism as the cause of hypoglycemia.

Findings:

  • Dasatinib, a TKI, was associated with refractory hypoglycemia in this pediatric patient.
  • Hyperinsulinism was the likely mechanism behind the observed hypoglycemia.
  • Diazoxide effectively controlled the patient's hypoglycemic symptoms.

Implications:

  • This case highlights a potential, previously undocumented TKI-induced endocrinopathy in pediatric oncology.
  • Further research is needed to explore the relationship between TKIs and glycemic dysregulation in children.
  • Identifying risk factors and pathophysiology is essential for proactive management of TKI side effects in pediatric patients.

Keywords:
dasatinibhyperinsulinismhypoglycemialeukemiatyrosine kinase inhibitor

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