Thyrotoxic Periodic Paralysis, β2-ADrenergic Bronchodilator, and Insulin—An Interesting Interplay

摘要

To the editor: The article by Yeh andcolleagues1 is indeed interesting.The occurrence of hypokalemiawas attributed to the effects ofa b2-adrenergic bronchodilator onthe membrane-bound sodium potassium adenosine triphosphatasepump, resulting in a skewed distribution of potassium and producingan extracellular to intracellular shift.This potassium shift resulted inthyrotoxic periodic paralysis (TPP).In addition to an increased adrenergic response, patients with TPPhave hyperinsulinemia during acuteattacks with an exaggerated insulinresponse to an oral glucose challenge, compared to thyrotoxic patients without TPP. This furthersupports the idea that insulin playsa pivotal role in the pathogenesis ofhypokalemia in TPP.