RSS Feeds
Two Cases of Severe Clinical and Histologic Hepatotoxicity Associated with Troglitazone
- Norman Gitlin, MD;
- Neil L. Julie, MD;
- Charles L. Spurr, MD;
- Kie N. Lim, MD; and
- Herbert M. Juarbe, MD
- From Emory University School of Medicine and Shady Grove Adventist Hospital, Atlanta, Georgia. Requests for Reprints: Norman Gitlin, MD, Emory University School of Medicine, Division of Digestive Diseases, WMB 2101, Pierce Drive, Atlanta, GA 30322. Current Author Addresses: Drs. Gitlin and Lin: Emory University School of Medicine, Division of Digestive Diseases, WMB 2101, Pierce Drive, Atlanta, GA 30322.
Several oral antihyperglycemic agents are available for management of type 2 diabetes. These agents generally fall into the chemical or function groups sulfonylureas, biguanides, or α-glucosidase inhibitors. Recently, the U.S. Food and Drug Administration approved troglitazone (Rezulin, Parke-Davis, Morris Plains, New Jersey), a thiazolidinedione agent that is unrelated to the aforementioned categories, as a novel oral antihyperglycemic agent. It decreases hepatic glucose output and increases insulin-dependent glucose metabolism in skeletal muscle [1, 2]. It is not an insulin secretagogue. We report two patients who had severe hepatotoxicity associated with troglitazone administration.
Patient 1
A 44-year-old woman with a history of type 1 diabetes mellitus since 1978 presented with nausea, low-grade fever, and progressive jaundice. She had required insulin for diabetes control for 10 years. Comorbid conditions included essential hypertension, hypothyroidism, and obesity. The patient had started taking troglitazone 20 weeks before presentation. Initially, she received 200 mg daily for 4 weeks, then received 400 mg daily thereafter. Before starting therapy, the patient's hepatic biochemical markers were normal. Other medications included lisinopril, 20 mg/d; levothyroxine sodium, 88 µg/d; and insulin. The patient reported no history of exposure to hepatotoxins or alcohol ingestion. On examination, the patient was icteric, and her liver was tender and enlarged to 14 cm; …
