Comparison of Continuous Glucose Monitoring (CGM) Values before and after Adrenalectomy in a Case of Adrenaline-producing Pheochromocytoma

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  • Kondo Takeshi
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Kuroda Akio
    Diabetes Therapeutics and Research Center, The University of Tokushima
  • Sogabe Kimiko
    The Post-graduate Education Center, Tokushima University Hospital
  • Ohguro Yukari
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Kurahashi Kiyoe
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Tamaki Motoyuki
    Diabetes Therapeutics and Research Center, The University of Tokushima
  • Kinouchi Mizuho
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Yoshida Sumiko
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Aki Nanako
    Clinical Research Center for Diabetes, The Tokushima University Hospital
  • Endo Itsuro
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Aihara Ken-ichi
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences
  • Fujinaka Yuichi
    Department of Internal Medicine, Local Incorporated Administrative Agency, Tokushima Prefecture Naruto Hospital
  • Matsuhisa Munehide
    Diabetes Therapeutics and Research Center, The University of Tokushima
  • Matsumoto Toshio
    Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences

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Other Title
  • 術前後で持続血糖モニター（CGM）を比較しえたアドレナリン優位褐色細胞腫の1例
  • 症例報告 術前後で持続血糖モニター(CGM)を比較しえたアドレナリン優位褐色細胞腫の1例
  • ショウレイ ホウコク ジュツゼン ゴ デ ジゾク ケットウ モニター(CGM)オ ヒカク シエタ アドレナリン ユウイ カッショク サイボウ シュ ノ 1レイ

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Abstract

A 77-year-old woman was incidentally found to have a left adrenal mass measuring 2.5 cm in January 2012. The urine metanephrine concentration was 3.0 mg/day (normal range, 0.04-0.19 mg/day), and an iodine-131 metaiodobenzylguanidine (MIBG) scan showed uptake in the area of the left adrenal gland, leading to a diagnosis of pheochromocytoma. In addition, the patient had a history of diabetes mellitus for nine years, with gradually worsening blood glucose control since 2010. The patient was subsequently admitted to our hospital for perioperative care. On admission, her fasting blood glucose level was 121 mg/dl and her HbA1c level was 8.5 %. She was treated with basal-bolus insulin therapy during hospitalization and underwent adrenalectomy at the urology department after her glycemic control had improved. The total daily insulin dose was immediately decreased from 50 to 14 units after the adrenalectomy procedure. In addition, the mean glucose level on preoperative continuous glucose monitoring (CGM) had been 141 mg/dl with a standard deviation (SD) of 54. However, after the operation, the mean glucose level increased to 153 mg/dl while the SD decreased to 24; thus, the range of glycemic fluctuation markedly decreased after surgery. Therefore, excess endogenous adrenalin primarily contributed to the glycemic fluctuations observed in this patient with pheochromocytoma.

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