Academic Title Case: Paediatric Glucocorticoid-Induced Hyperglycemia and Diabetic Ketoacidosis: An Under-Recognized Complication of Cancer Therapy
https://doi.org/10.15605/jafes.041.S1
- Author:
Sasirekha Krisnan Morthy
1
;
Annie Leong
1
;
Nurshadia Samingan
1
;
Azriyanti Anuar Zaini
1
Author Information
1. Paediatric Endocrine Unit, Department of Paediatric, University Malaya Medical Centre
- Publication Type:Journal Article
- MeSH:
Child;
Diabetic Ketoacidosis;
Glucocorticoids;
Neoplasms;
Hyperglycemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):139-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Paediatric glucocorticoid-induced hyperglycemia (GIH)
and diabetes are frequently under-recognized complications of cancer therapy. Early identification is essential,
as delayed diagnosis may lead to severe metabolic
consequences, including diabetic ketoacidosis (DKA). This
study aims to characterize the clinical features, risk factors,
and outcomes of GIH in a tertiary centre.
Methodology:A descriptive cross-sectional study was conducted at the
Paediatric Endocrinology Unit, University Malaya Medical
Centre, reviewing cases from January 2023 to December
2025. Data were extracted from electronic records, including
demographic, clinical, and treatment-related variables.
Results:Twelve cases of GIH or diabetes were identified, including
two presenting with DKA. Most patients had leukemia
(92%), with a male predominance (75%). The median age
was 13.6 years, and the median body mass index was 22.1
kg/m². Over half (54%) were overweight or obese, and 45%
exhibited acanthosis nigricans. A family history of diabetes
was present in 75% of cases.
Hyperglycemia developed early in 66% of cases, typically
within 2–5 days of initiating high-dose glucocorticoids.
Median random blood glucose was 21.9 mmol/L, while
median HbA1c was 6.4%. Half were symptomatic, most
commonly with polyuria. Insulin therapy was required in
75% of cases, with a median duration of 26 days. Metformin
was used in 50% of cases, often in combination with insulin.
Most cases resolved following cessation of glucocorticoid
therapy, except one who continues to receive metformin
for a pre-diabetes state.
Conclusion:Adolescents, those with obesity, insulin resistance, and
a positive family history of diabetes, represent highrisk groups for GIH. Importantly, GIH may present
with life-threatening DKA. Routine glucose monitoring
and risk stratification during glucocorticoid therapy are
recommended. The development of local screening and
management guidelines is crucial for improving early
detection and optimizing patient outcomes.
- Full text:2026081013262577785EP_P009.pdf
