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POEMS Syndrome

(Crow-Fukase Syndrome; Takatsuki Disease; PEP Syndrome)


Jennifer M. Barker

, MD, Children's Hospital Colorado, Division of Pediatric Endocrinology

Last full review/revision Mar 2021| Content last modified Mar 2021
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POEMS syndrome is a rare disorder in which more than one endocrine gland is dysfunctional.

Endocrine glands are organs that secrete one or more specific hormones. POEMS syndrome is probably caused by antibodies (immunoglobulins) that circulate in the blood and damage organs, particularly endocrine glands. Antibodies are produced by cells called plasma cells. In certain plasma cell disorders, abnormal plasma cells multiply and produce excessive amounts of an antibody that damages organs.

POEMS syndrome is named for the signs and symptoms that commonly occur in affected people:

  • Polyneuropathy (nerve damage)

  • Organomegaly (enlargement of the liver, spleen, and lymph nodes)

  • Endocrinopathy (abnormal hormone levels)

  • Monoclonal gammopathy (abnormal blood antibodies)

  • Skin changes

People may have the following:

  • Liver enlargement

  • Swollen lymph glands

  • Low levels of testosterone (hypogonadism)

  • Low levels of thyroid hormone (hypothyroidism)

  • High levels of parathyroid hormone (hyperparathyroidism)

  • Underactive adrenal glands (Addison disease)

  • Excess production of some antibodies (gammopathy)

  • Skin abnormalities, such as darkening and thickening of the skin, hairiness, and small bright red patches (angiomas)

  • Areas of bone destruction

Fluid may accumulate in the legs, abdomen, space between the layers of the membrane surrounding the lungs (called the pleural space), or near the optic nerve. Fluid accumulation in the pleural space causes difficulty breathing and chest pain. Fluid that accumulates near the optic nerve and presses on it causes vision problems. People may also have fever.

POEMS syndrome is diagnosed based on the presence of certain symptoms and findings during a doctor's physical examination, and certain laboratory test abnormalities in antibody and hormone levels.

Treatment of POEMS Syndrome

  • Radiation therapy

  • Chemotherapy

Treatment consists of radiation therapy and chemotherapy to reduce the number of abnormal plasma cells sometimes followed by autologous stem cell transplantation. About 60% of affected people survive for 5 years after diagnosis.

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Drug Treatment of Diabetes Mellitus
Many people with diabetes mellitus require drugs to lower blood glucose levels, relieve symptoms, and prevent complications. Insulin is a commonly-needed drug by people with both type 1 and type 2 diabetes. Which of the following is NOT one of the forms in which insulin is currently available?
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