Early diagnosis of capivasertib-associated severe hyperglycemia with diabetic ketosis diagnosed in routine clinical practice: a case report with review of literature.
Masashi Yoshikawa, Keiichiro Takahashi, Satoshi Yoshino et al.
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Case in brief
A 61-year-old woman without known glucose intolerance developed severe hyperglycemia with diabetic ketosis within 4 days of starting capivasertib for advanced breast cancer. At a scheduled outpatient visit she was asymptomatic, but her random plasma glucose was 482 mg/dL and serum insulin was markedly elevated at 591.9 μU/mL, consistent with preserved β-cell function and severe insulin resistance. Glucose levels improved rapidly within 2 days of admission with fluid replacement and minimal insulin therapy.
What made this case unusual
Severe hyperglycemia and ketosis were detected while the patient remained asymptomatic, through a proactively scheduled outpatient visit rather than after symptom-driven presentation.
Diagnostic / clinical pearl
Capivasertib-associated severe hyperglycemia can arise within days and may be asymptomatic, even without pre-existing glucose intolerance or with preserved insulin secretion; early glucose monitoring can identify it.
Why it matters
The case supports proactive glucose monitoring during the first week of capivasertib therapy, particularly near the end of the initial dosing cycle, alongside patient education and timely diabetes-specialist consultation.