A 72-year-old man with a history of type 2 diabetes mellitus, hypercholesterolemia, prostate adenoma and colon polypectomy in 2010 was treated with insulin glargine.
He came to the consultation due to a picture of loss of strength and acute symmetrical pain in the groin, which was later added pain in both shoulders of about three weeks of evolution.
Physical examination revealed proximal weakness of the scapular and pelvic girdles.
With the suspicion of polymyalgia rheumatica, an analytical test with acute phase reactants is requested and oral corticosteroid therapy (prednisone 30 mg/day) is initiated, expecting a rapid and important initial response.
Laboratory tests showed CRP of 141 mg/dl (normal 0-10 mg/dl) and VSG 12 mm (normal 0-20 mm/1h) with normal biochemistry, thyroid hormones and blood count, except for some leukocytosis with
One week after starting treatment with corticosteroids, a favorable but incomplete response was observed.
The patient maintains good general health and appetite, although he comments weight loss.
It also worsens blood glucose levels, especially with postprandial hyperglycaemia.
As we have mentioned, this is an insulin-dependent diabetic patient who has received corticoid therapy.
Glycaemic control is important in these patients.
Therefore, we added the fast-acting insulin (insulin aspart) treatment.
Hyperglycemia greater than 200 mg/dl is a common situation when medium-high doses of corticosteroids are used in patients with known previous diabetes and in those who develop steroid diabetes.
Insulin is usually the treatment of choice in glucocorticoid-induced hyperglycemia for reasons of efficacy and safety3.
Having diagnostic doubts and incomplete response, a new analytical study is carried out to assess the evolution of acute phase reactants.
High CRP persists in this patient (60 mg/dl) and normocytic anemia is also observed.
Given the history of benign prostatic hyperplasia, the study was completed with a systematic analysis and urine sediment, urocultiva and PSA, which is 12.87 (with a previous year being suspected 6.3), so the syndrome is possible.
The rectal examination showed an increase in the prostate, painful on touch with a palpable nodule in the right lobe.
The patient was referred to the urology department for evaluation, where a prostatic biopsy was performed confirming the diagnosis of adenocarcinoma, compatible with a Gleason grade VI (3+3), and extension study with bone scintigraphy and MRI.
Treatment with monotherapy and subsequent radiotherapy was initiated, with good response from the initial clinical symptoms.
Having established the findings, it is considered that it is a paraneoplastic syndrome associated with prostate tumor in this case.
