Peptide Receptor Radionuclide Therapy-Induced Gitelman-like Syndrome

Abstract

Peptide receptor radionuclide therapy (PRRT) is a molecular-targeted therapy in which a somatostatin analogue (a small peptide) is coupled with a radioligand so that the radiation dose is selectively administered to somatostatin receptor-expressing metastasized neuroendocrine tumors, particularly gastroenteropancreatic. Reported toxicities include myelotoxicity and nephrotoxicity, the latter manifesting as decreased kidney function, often developing months to years after treatment completion. We present a case of PRRT-induced kidney toxicity manifesting as a severe Gitelman-like tubulopathy with preserved kidney function. Because profound hypokalemia and hypocalcemia can lead to life-threatening arrhythmias, we highlight the necessity for careful monitoring of serum and urine electrolytes in patients receiving PRRT.

Keywords: 177-Lu-DOTATATE; Gitelman; Peptide receptor radionuclide therapy (PRRT); cancer; case report; hypocalcemia; hypokalemia; hypomagnesemia; nephrotoxicity; neuroendocrine tumors (NETs); radiometabolic; tubulopathy; urine electrolytes.