Top

Published in:

Open Access 01-12-2011 | Case report

White fat, factitious hyperglycemia, and the role of FDG PET to enhance understanding of adipocyte metabolism

Authors: Michael S Hofman, Rodney J Hicks

Published in: EJNMMI Research | Issue 1/2011

Abstract

The development of a hybrid PET/CT led to the recognition of the enhanced glycolysis in brown fat. We report a previously unrecognized mechanism for altered fluorodeoxyglucose (FDG) biodistribution with diffuse white adipose tissue uptake. This occurred during a restaging scan for cervical cancer following administration of insulin in the setting of measured hyperglycemia. The patient's blood sugar normalized, but she experienced symptoms and signs of hypoglycemia. A subsequent history indicated that the patient received intravenous high-dose vitamin C just prior to arrival. Ascorbic acid is a strong reducing agent and can cause erroneous false positive portable glucometer readings. Accordingly, it is likely the patient was euglycemic on arrival and was administered FDG during a period of insulin-induced hypoglycemia. Prominent diffuse white adipose tissue, gastric mucosal, myocardial, and very low hepatic and muscle activity were observed. The case provides insight into the metabolic changes that occur during hypoglycemia and the potential danger of relying on portable glucometer readings. We discuss the potential biological basis of this finding and provide recommendations on the avoidance of this complication.

Available only for authorised users

Cohade C, Osman M, Pannu HK, Wahl RL: Uptake in supraclavicular area fat ("USA-Fat"): description on 18F-FDG PET/CT. J Nucl Med 2003, 44: 170–176.PubMed

Hany TF, Gharehpapagh E, Kamel EM, Buck A, Himms-Hagen J, von Schulthess GK: Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region. Eur J Nucl Med Mol Imaging 2002, 29: 1393–1398. 10.1007/s00259-002-0902-6PubMedCrossRef

Cypess AM, Lehman S, Williams G, Tal I, Rodman D, Goldfine AB, Kuo FC, Palmer EL, Tseng YH, Doria A, Kolodny GM, Kahn CR: Identification and importance of brown adipose tissue in adult humans. N Engl J Med 2009, 360: 1509–1517. 10.1056/NEJMoa0810780PubMedCentralPubMedCrossRef

Tang Z, Du X, Louie RF, Kost GJ: Effects of drugs on glucose measurements with handheld glucose meters and a portable glucose analyzer. Am J Clin Pathol 2000, 113: 75–86. 10.1309/QAW1-X5XW-BVRQ-5LKQPubMedCrossRef

Siest G, Appel W, Blijenberg GB, Capolaghi B, Galteau MM, Heusghem C, Hjelm M, Lauer KL, Le Perron B, Loppinet V, Love C, Royer RJ, Tognoni C, Wilding P: Drug interference in clinical chemistry: studies on ascorbic acid. J Clin Chem Clin Biochem 1978, 16: 103–110.PubMed

Turcotte E, Leblanc M, Carpentier A, Benard F: Optimization of whole-body positron emission tomography imaging by using delayed 2-deoxy-2-[F-18]fluoro-D: -glucose Injection following I.V. Insulin in diabetic patients. Mol Imaging Biol 2006, 8: 348–354. 10.1007/s11307-006-0064-1PubMedCrossRef

Roy FN, Beaulieu S, Boucher L, Bourdeau I, Cohade C: Impact of intravenous insulin on 18F-FDG PET in diabetic cancer patients. J Nucl Med 2009, 50: 178–183. 10.2967/jnumed.108.056283PubMedCrossRef

Chen Q, Espey MG, Sun AY, Pooput C, Kirk KL, Krishna MC, Khosh DB, Drisko J, Levine M: Pharmacologic doses of ascorbate act as a prooxidant and decrease growth of aggressive tumor xenografts in mice. Proc Natl Acad Sci USA 2008, 105: 11105–11109. 10.1073/pnas.0804226105PubMedCentralPubMedCrossRef

Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC: Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 1998, 280: 1569–1575. 10.1001/jama.280.18.1569PubMedCrossRef

10.

Kannan S, Rowland CH, Hockings GI, Tauchmann PM: Intragam can interfere with blood glucose monitoring. Med J Aust 2004, 180: 251–252.PubMed

11.

Korsatko S, Ellmerer M, Schaupp L, Mader JK, Smolle KH, Tiran B, Plank J: Hypoglycaemic coma due to falsely high point-of-care glucose measurements in an ICU-patient with peritoneal dialysis: a critical incidence report. Intensive Care Med 2009, 35: 571–572. 10.1007/s00134-008-1362-7PubMedCrossRef

12.

Schleis TG: Interference of maltose, icodextrin, galactose, or xylose with some blood glucose monitoring systems. Pharmacotherapy 2007, 27: 1313–1321. 10.1592/phco.27.9.1313PubMedCrossRef

13.

Medicines and Healthcare Products Regulatory Agency, Medical Device Alert MDA/2003/001 [http://glucosesafety.com/uk/pdf/MDA-2007–058%20updated.pdf]

14.

Kaufmann PA, Di Carli MF: Hybrid SPECT/CT and PET/CT imaging: the next step in noninvasive cardiac imaging. Semin Nucl Med 2009, 39: 341–347. 10.1053/j.semnuclmed.2009.03.007PubMedCrossRef

15.

Kirrane BM, Duthie EA, Nelson LS: Unrecognized hypoglycemia due to maltodextrin interference with bedside glucometry. J Med Toxicol 2009, 5: 20–23. 10.1007/BF03160976PubMedCentralPubMedCrossRef

16.

vom Dahl J, Herman WH, Hicks RJ, Ortiz-Alonso FJ, Lee KS, Allman KC, Wolfe ER, Kalff V, Schwaiger M: Myocardial glucose uptake in patients with insulin-dependent diabetes mellitus assessed quantitatively by dynamic positron emission tomography. Circulation 1993, 88: 395–404.PubMedCrossRef

17.

Cryer PE, Gerich JE: Glucose counterregulation, hypoglycemia, and intensive insulin therapy in diabetes mellitus. N Engl J Med 1985, 313: 232–241. 10.1056/NEJM198507253130405PubMedCrossRef

18.

Habegger KM, Heppner KM, Geary N, Bartness TJ, DiMarchi R, Tschop MH: The metabolic actions of glucagon revisited. Nat Rev Endocrinol 2010, 6: 689–697. 10.1038/nrendo.2010.187PubMedCentralPubMedCrossRef

19.

Tesfaye N, Seaquist ER: Neuroendocrine responses to hypoglycemia. Ann N Y Acad Sci 2010, 1212: 12–28. 10.1111/j.1749-6632.2010.05820.xPubMedCentralPubMedCrossRef

20.

Perea A, Clemente F, Martinell J, Villanueva-Penacarrillo ML, Valverde I: Physiological effect of glucagon in human isolated adipocytes. Horm Metab Res 1995, 27: 372–375. 10.1055/s-2007-979981PubMedCrossRef

21.

Brito NA, Brito MN, Bartness TJ: Differential sympathetic drive to adipose tissues after food deprivation, cold exposure or glucoprivation. Am J Physiol Regul Integr Comp Physiol 2008, 294: R1445–1452. 10.1152/ajpregu.00068.2008PubMedCrossRef

22.

Parysow O, Mollerach AM, Jager V, Racioppi S, San Roman J, Gerbaudo VH: Low-dose oral propranolol could reduce brown adipose tissue F-18 FDG uptake in patients undergoing PET scans. Clin Nucl Med 2007, 32: 351–357. 10.1097/01.rlu.0000259570.69163.04PubMedCrossRef

23.

Xu J, Stanislaus S, Chinookoswong N, Lau YY, Hager T, Patel J, Ge H, Weiszmann J, Lu SC, Graham M, Busby J, Hecht R, Li YS, Lindberg RA, Veniant MM: Acute glucose-lowering and insulin-sensitizing action of FGF21 in insulin resistant mouse models - association with liver and adipose tissue effects. Am J Physiol Endocrinol Metab 2009, in press.

24.

Domingo P, Gallego-Escuredo JM, Domingo JC, Gutierrez Mdel M, Mateo MG, Fernandez I, Vidal F, Giralt M, Villarroya F: Serum FGF21 levels are elevated in association with lipodystrophy, insulin resistance and biomarkers of liver injury in HIV-1-infected patients. AIDS 2010, 24: 2629–2637. 10.1097/QAD.0b013e3283400088PubMedCrossRef

25.

Sathekge M, Maes A, Kgomo M, Stolz A, Ankrah A, Van de Wiele C: Evaluation of glucose uptake by skeletal muscle tissue and subcutaneous fat in HIV-infected patients with and without lipodystrophy using FDG-PET. Nucl Med Commun 2010, 31: 311–314. 10.1097/MNM.0b013e3283359058PubMedCrossRef

26.

Clarke JR, Brglevska S, Lau EW, Ramdave S, Hicks RJ: Atypical brown fat distribution in young males demonstrated on PET/CT. Clin Nucl Med 2007, 32: 679–682. 10.1097/RLU.0b013e318126c01cPubMedCrossRef

27.

Campion J, Milagro FI, Fernandez D, Martinez JA: Vitamin C supplementation influences body fat mass and steroidogenesis-related genes when fed a high-fat diet. Int J Vitam Nutr Res 2008, 78: 87–95. 10.1024/0300-9831.78.2.87PubMedCrossRef

28.

Baba S, Jacene HA, Engles JM, Honda H, Wahl RL: CT Hounsfield units of brown adipose tissue increase with activation: preclinical and clinical studies. J Nucl Med 2010, 51: 246–250. 10.2967/jnumed.109.068775PubMedCrossRef

29.

Astrup A, Bulow J, Madsen J: Interscapular brown adipose tissue blood flow in the rat. Determination with 133xenon clearance compared to the microsphere method. Pflugers Arch 1984, 401: 414–417. 10.1007/BF00584345PubMedCrossRef

30.

Vazquez-Vela ME, Torres N, Tovar AR: White adipose tissue as endocrine organ and its role in obesity. Arch Med Res 2008, 39: 715–728. 10.1016/j.arcmed.2008.09.005PubMedCrossRef

Title: White fat, factitious hyperglycemia, and the role of FDG PET to enhance understanding of adipocyte metabolism
Authors: Michael S Hofman
Rodney J Hicks
Publication date: 01-12-2011
Publisher: Springer Berlin Heidelberg
Published in: EJNMMI Research / Issue 1/2011
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/2191-219X-1-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

White fat, factitious hyperglycemia, and the role of FDG PET to enhance understanding of adipocyte metabolism

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2011

Inert coupling of IRDye800CW to monoclonal antibodies for clinical optical imaging of tumor targets

Computer-aided diagnosis of renal obstruction: utility of log-linear modeling versus standard ROC and kappa analysis

Use of a beta microprobe system to measure arterial input function in PET via an arteriovenous shunt in rats

Syndecan-1 antigen, a promising new target for triple-negative breast cancer immuno-PET and radioimmunotherapy. A preclinical study on MDA-MB-468 xenograft tumors

Evaluation of 18F-nifene binding to α4β2 nicotinic receptors in the rat brain using microPET imaging

Suitability of bilateral filtering for edge-preserving noise reduction in PET