Diabetic Ketoacidosis Triggered by Anamorelin in a Pancreatic Cancer Patient Without Pre-existing Diabetes or Prior Dexamethasone Use: A Case Report

Abstract

A 72-year-old man was diagnosed with pancreatic cancer and multiple lung metastases at 70 years of age. Despite chemotherapy, the disease progressed. He subsequently underwent proton beam therapy at his own expense, which reduced both lesions. He developed anorexia and weight loss due to cancer cachexia, for which anamorelin hydrochloride was prescribed. At initiation, the patient had no history of diabetes mellitus or dexamethasone use. Three weeks later, hyperglycemic symptoms appeared. On day 41, the patient developed diabetic ketoacidosis (DKA), necessitating urgent hospitalization. After discontinuing anamorelin hydrochloride, his serum C-peptide levels increased, and eventually, his blood glucose levels were controlled without medication. To date, only two cases of DKA associated with anamorelin hydrochloride have been reported, both involved patients who were concurrently receiving antidiabetic medications and/or dexamethasone. In this case, neither of these contributing factors were present, suggesting that anamorelin hydrochloride alone may have contributed to the development of DKA. Clinicians should exercise caution when prescribing anamorelin hydrochloride to patients with malignancies, particularly pancreatic cancer.