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Age and Ageing 2006 35(4):448; doi:10.1093/ageing/afl029
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© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Clinical Reminder

Niacin toxicity: a rare presentation mimicking malignancy

Abraham Joseph1,*, Tarun Kothari2 and Sundar Venkatesh2

1 Fairmont Medical Center, 800 Clinic Circle, Fairmont, MN 56031, USA
2 Unity Health System, 1560 Long Pond Road, Rochester, New York, NY 14626, USA

* To whom correspondence should be addressed at: joseph.abraham{at}mayo.edu

A 79-year-old male patient presented with a 3-month history of significant weight loss and jaundice. Liver tests revealed significant elevation in alkaline phosphotase, gamma glutamyltranspeptidase and bilirubin levels. Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were also markedly elevated (Table 1). Painless jaundice and weight loss with elevated CA19-9 levels in an elderly patient led us to suspect pancreatic cancer. The patient did have an endoscopic retrograde cholangiopancreatography, abdominal computerised tomography scan and colonoscopy that were normal. The patient later revealed that he was taking non-prescription niacin, which was discontinued, and the patient’s liver tests, CEA and CA19-9 levels returned to normal (Table 1). He continued to improve and gain weight.


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  		Table 1.. Laboratory tests

 

Niacin is used to treat certain types of dyslipidaemias [1]. Flushing, hyperglycaemia, hyperuricaemia, thrombocytopenia, acanthosis nigricans, ichthyosis and hepatic dysfunction are some of the adverse effects [2]. Niacin has not been reported to cause elevation of tumour-associated antigens with symptoms and signs suggestive of underlying malignancy. Physicians need to be aware of this rare presentation mimicking malignancy caused by niacin to avoid expensive and potentially harmful procedures.


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 References
 

  1. Britton ML, Bradberry JC, Letassy NA et al. ASHP therapeutic position statement on the safe use of niacin in the management of dyslipidemias. American Society of Health-System Pharmacists. Am J Health Syst Pharm 1997; 54: 2815–19.[Abstract/Free Full Text]
  2. Knopp RH. Drug treatment of lipid disorders. N Engl J Med 1999; 341: 498–511.[Free Full Text]

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This Article
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