Sulfasalazine-Induced Hypoglycemia in a Patient with Type 2 Diabetes and End-Stage Renal Disease

ABSTRACT Objective: To demonstrate important points regarding the possible hypoglycemic effects of sulfasalazine and suggest possible underlying mechanism(s) accounting for sulfasalazine-induced hypoglycemia. Methods: We describe a case of reversible sulfasalazine-induced hypoglycemia, review the literature, and discuss a potential mechanism accounting for sulfasalazine-induced hypoglycemia. Results: A 63-year-old man with Crohn disease treated with sulfasalazine and type 2 diabetes complicated by end-stage renal disease was admitted for treatment of persistent hypoglycemia. Insulinoma was initially suspected, but localization studies including endoscopic ultrasound were negative. This raised the possibility of sulfasalazine-induced hypoglycemia. Three days after sulfasalazine was stopped, he became normoglycemic. Hypoglycemia has not recurred since discontinuing sulfasalazine. Conclusion: Clinicians should be aware of the potential hypoglycemic effect of sulfasalazine. Doses should be reduced in patients with impaired renal function, and it should be discontinued if otherwise unexplained hypoglycemia develops. Abbreviations: CT = computed tomography; ESRD = end-stage renal disease