SAT-548 Hypoglycemia Beyond Insulin: A Novel Link to Hydroxycarbamide Therapy

Abstract Disclosure: A. Hassan: None. A. Aslam: None. S. Dhage: None. Introduction and BackgroundHypoglycemia is a common occurrence in patients with diabetes mellitus and a few rare endocrine disorders including insulinoma. Hypoglycemia is a well-known adverse effect due to antidiabetic medications, but it can occasionally develop due to various other non-diabetes related medications including analgesics, antibacterial, antirheumatic and antidepressant drugs. We hereby report a case of hypoglycemia caused by hydroxycarbamide (hydroxyurea); a drug not typically associated with glucose-lowering effects. Case Report: A 72-year-old lady was referred by GP for symptoms suggestive of hypoglycemia. She was started on treatment with hydroxycarbamide for essential thrombocythemia since the last few months. Her hypoglycemic symptoms were associated with self-monitoring of capillary blood glucose (SMBG). Subsequent mixed meal test confirmed hypoglycemia with inappropriately high insulin and C-peptide levels. Patient was advised to stop her hydroxycarbamide temporarily for a few weeks. A 72-hour fast and MR imaging of pancreas were performed; and both were reported as negative for hypoglycemia and pancreatic lesion respectively. As her platelet count was creeping up slowly, hydroxycarbamide rechallenge was started. Patient started experiencing symptoms of hypoglycemia again with documented low capillary blood glucose levels on self-monitoring which were also confirmed on Continuous glucose monitoring (CGM).Hydroxycarbamide was permanently discontinued at this stage, and the patient was advised to follow a low-carbohydrate, high-protein diet. CGM and SMBG showed progressive improvement, with complete symptom resolution following cessation of the medication. Discussion: Discontinuation of hydroxycarbamide resulting in complete resolution of hypoglycemia and its symptoms helped to confirm the diagnosis in this patient. This case highlights the importance of awareness about possible adverse events due to drugs, irrespective of specialty involved. It also reinforces the importance of clinical recognition, thorough evaluation, and prompt management to ensure patient safety.In our knowledge, this is the first reported case of hypoglycemia caused by hydroxycarbamide (hydroxyurea). Details of the case and relevant review of literature will be presented as part of this case report. Presentation: Saturday, July 12, 2025