Early diagnosis of capivasertib-associated severe hyperglycemia with diabetic ketosis diagnosed in routine clinical practice: a case report with review of literature
Abstract
Capivasertib, an oral pan-AKT inhibitor, is a therapeutic option for hormone receptor-positive advanced breast cancer. While hyperglycemia is a recognized adverse effect of AKT inhibition, its diagnosis is often delayed in routine clinical practice. We report a case of acute-onset severe hyperglycemia with diabetic ketosis identified within 4 days of initiating capivasertib in a patient without pre-existing glucose intolerance. A 61-year-old woman developed marked hyperglycemia (random plasma glucose, 482 mg/dL) with ketosis, despite being asymptomatic. Laboratory evaluation showed markedly elevated serum insulin (591.9 μU/mL), indicating preserved pancreatic β-cell function and severe insulin resistance. Blood glucose levels improved rapidly within 2 days of admission using minimal insulin therapy and fluid replacement. Unlike previously reported cases identified after symptomatic presentation, including emergency department visits, or under intensive inpatient monitoring, this case was detected through a proactively scheduled outpatient visit on day 4-strategically timed to coincide with the end of the first dosing cycle based on the drug's pharmacological profile. This observation highlights that severe hyperglycemia can develop very early and remain asymptomatic, underscoring the importance of proactive detection. Therefore, even in patients without pre-existing glucose intolerance or with preserved insulin secretion, proactive glucose monitoring during the first week of therapy, specifically near the end of the initial dosing cycle, is essential to prevent severe metabolic complications. Appropriate patient education and early consultation with diabetes specialists are also crucial for timely management.
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BibTeX
@article{yoshikawa2026early,
title = {{Early diagnosis of capivasertib-associated severe hyperglycemia with diabetic ketosis diagnosed in routine clinical practice: a case report with review of literature}},
author = {Masashi Yoshikawa and Keiichiro Takahashi and Satoshi Yoshino and Yutaka Watanuki and Aya Osaki and Hiroki Ito and Masaya Uehara and Keiko Tanabe and Sasagu Kurozumi and Shunichi Matsumoto and Kazuhiko Horiguchi and Eijiro Yamada},
journal = {Endocrine Journal},
year = {2026},
month = nov,
doi = {10.1507/endocrj.ej26-0035},
url = {https://www.jstage.jst.go.jp/article/endocrj/73/11/73_EJ26-0035/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Early diagnosis of capivasertib-associated severe hyperglycemia with diabetic ketosis diagnosed in routine clinical practice: a case report with review of literature
AU - Masashi Yoshikawa
AU - Keiichiro Takahashi
AU - Satoshi Yoshino
AU - Yutaka Watanuki
AU - Aya Osaki
AU - Hiroki Ito
AU - Masaya Uehara
AU - Keiko Tanabe
AU - Sasagu Kurozumi
AU - Shunichi Matsumoto
AU - Kazuhiko Horiguchi
AU - Eijiro Yamada
PY - 2026
DA - 2026/11/02
JO - Endocrine Journal
DO - 10.1507/endocrj.ej26-0035
UR - https://www.jstage.jst.go.jp/article/endocrj/73/11/73_EJ26-0035/_article
AB - Capivasertib, an oral pan-AKT inhibitor, is a therapeutic option for hormone receptor-positive advanced breast cancer. While hyperglycemia is a recognized adverse effect of AKT inhibition, its diagnosis is often delayed in routine clinical practice. We report a case of acute-onset severe hyperglycemia with diabetic ketosis identified within 4 days of initiating capivasertib in a patient without pre-existing glucose intolerance. A 61-year-old woman developed marked hyperglycemia (random plasma glucose, 482 mg/dL) with ketosis, despite being asymptomatic. Laboratory evaluation showed markedly elevated serum insulin (591.9 μU/mL), indicating preserved pancreatic β-cell function and severe insulin resistance. Blood glucose levels improved rapidly within 2 days of admission using minimal insulin therapy and fluid replacement. Unlike previously reported cases identified after symptomatic presentation, including emergency department visits, or under intensive inpatient monitoring, this case was detected through a proactively scheduled outpatient visit on day 4-strategically timed to coincide with the end of the first dosing cycle based on the drug's pharmacological profile. This observation highlights that severe hyperglycemia can develop very early and remain asymptomatic, underscoring the importance of proactive detection. Therefore, even in patients without pre-existing glucose intolerance or with preserved insulin secretion, proactive glucose monitoring during the first week of therapy, specifically near the end of the initial dosing cycle, is essential to prevent severe metabolic complications. Appropriate patient education and early consultation with diabetes specialists are also crucial for timely management.
SN - 1348-4540
SN - 0918-8959
ER -