The 48-year-old chief executive officer of a leading auto manufacturer is put on niacin and a restricted diet for the treatment of high-LDL cholesterol.
HPI The patient is a "bon vivant" who enjoys drinking and eating gourmet food as well as smoking two packs a day of Cuban filter-free dark tobacco cigarettes. On a visit two months afterward, the patient's lab tests show improvement, but he complains of facial flushing and itching on the lower back, palms, and anus.
Labs Serum glucose elevated (157 mg/dL); LDL lowered considerably in comparison to last visit; triglycerides decreased, but not as markedly; HDL increased; AST and ALT mildly elevated; elevated uric acid; normal levels of 5-hydroxyindoleacetic acid (vs. carcinoid syndrome, which may also produce facial Hushing)
Imaging CXR: normal.
Treatment Flushing and itching are often transient. Aspirin diminishes symptoms by inhibiting prostaglandin synthesis.
Discussion Nicotinic acid (niacin) is a derivative of tryptophan, a constituent of NAD and NADP that is used in redox reactions. As a drug, it is used for its lipid-lowering properties (decreases VLDL, decreases LDL, and increases HDL cholesterol). Hepatitis, hyperglycemia, and exacerbation of peptic ulcer are other side effects.
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