A 45-year-old woman with type 2 diabetes and obesity is being considered for liraglutide therapy. Which of the following findings is an absolute contraindication to initiating a GLP-1 receptor agonist?
- A Diabetic retinopathy
- B Mild hepatic impairment (Child-Pugh A)
- C History of medullary thyroid carcinoma ✓
- D Pancreatic insufficiency
Correct answer: C. History of medullary thyroid carcinoma
Explanation
GLP-1 receptor agonists carry a boxed warning for medullary thyroid carcinoma (MTC). They are contraindicated in patients with personal or family history of MTC or MEN2, as rodent studies showed B-cell tumors. Diabetic retinopathy is not an absolute contraindication (though rapid worsening was noted with semaglutide in SUSTAIN-6). Hepatic impairment and pancreatic insufficiency are not contraindications.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
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