Causes and Evaluation of Tumor-Induced Hypoglycemia

Immerman, Steven C.; Sener, Stephen F.; Khandekar, Janardan D.

doi:10.1001/archsurg.1982.01380310025006

Cited by 14 publications

(9 citation statements)

References 20 publications

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“…TAH has been associated with both SFT, and fibrosarcoma of the liver . PET scan in the present patient did not demonstrate any areas of hypermetabolism, and thus excessive utilization of glucose by the tumor was not the mechanism of the hypoglycemia.…”

Section: Discussioncontrasting

confidence: 39%

Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia

Chan

Horton

Thyssen

et al. 2007

J Hepatobiliary Pancreat Surg

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Sarcomas of the liver are rare. We report a case of intractable hypoglycemia secondary to a solitary fibrous tumor that underwent malignant transformation into a fibrosarcoma. A 70-year-old man presented with a hepatic mass and tumor-associated hypoglycemia which was resistant to medical management. Blood tests were remarkable only for elevated serum insulin-like growth factor (IGF)-2. The hypoglycemia resolved following resection of a solitary fibrous tumor surrounded by a high-grade fibrosarcoma. Real time reverse transcriptase polymerase chain reaction (RT-PCR) measured elevated levels of IGF2 mRNA in both the solitary fibrous tumor and the fibrosarcoma. Immunoblotting demonstrated a series of bands in the size range of pro-IGF2. Unfortunately, disseminated metastases developed 1 year later, concurrent with a recurrence of hypoglycemia, marked again by elevation of serum IGF2. Solitary fibrous tumors of the liver have a real risk of malignant transformation. The severity of the tumor-associated hypoglycemia may parallel the tumor burden and activity. The syndrome is the systemic effect of IGF2 secreted by the tumor. Surgery can treat the hypoglycemia syndrome and the underlying malignancy.

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Section: Discussioncontrasting

confidence: 39%

Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia

Chan

Horton

Thyssen

et al. 2007

J Hepatobiliary Pancreat Surg

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“…Reports of patients with primary hepatic fibrosarcoma are rare, while 20% of these patients are associated with hypoglycemia as a paraneoplastic syndrome (1)(2)(3)(4)(5)(6). The insulin-like growth factor-II (IGF-II) produced by certain mesenchymal or epithelial tumors is thought to be responsible for the development of hypoglycemia in some cases (7,8).…”

Section: Introductionmentioning

confidence: 99%

IGF-II Producing Hepatic Fibrosarcoma Associated with Hypoglycemia.

et al. 1993

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A 67-year-old male was admitted with the complaint of weakness at hunger early in the morning, when blood glucose was less than 40 mg/dl. The abdominal ultrasonogram and computerized tomogram demonstrated a huge tumor in the right liver lobe. Hypoglycemia disappeared after transcatheter arterial embolization. Then hepatic lobectomy was performed. The tumor was histologically shown to be a fibrosarcoma. Insulin-like growth factor-II was intensely stained in the Golgi area of the tumor cells, suggesting its role in the mechanismof hypoglycemia. (Internal Medicine 32: 897-901, 1993)

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“…Hypoglycemia due to non-pancreatic tumours is infrequently reported and poorly understood. Various mechanisms were proposed [1] are: (a) insulin or insulin-like activity produced by the tumour, (b) decreased gluconeogenesis, (c) disruption of glucagon metabolism, and (d) increased utilization of glucose by the tumour. The non-suppressible Insulin like Activity (NSILA) has been purposed to be secondary to Insulin like Growth Factor-2.…”

Section: Discussionmentioning

confidence: 99%

Ectopic insulin secreting neuroendocrine tumor of kidney with recurrent hypoglycemia: a diagnostic dilemma

et al. 2014

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BackgroundHypoglycemia secondary to ectopic insulin secretion of non-pancreatic tumors is rare.Case presentationWe describe a middle aged woman with recurrent hypoglycemia. On evaluation, she was detected to have hyperinsulinemic hypoglycemia and right sided renal mass lesion. 68Ga-Dotanoc and 99mTc-HYNICTOC scans confirmed the intrarenal mass to be of neuroendocrine origin. Right nephrectomy was done and it turned out to be an insulin secreting neuroendocrine tumour. Neuroendocrine nature of this tumour was further confirmed by ultra-structural examination. Her hypoglycemia did not recur after resection of this tumour.ConclusionFew cases of ectopic insulin secretion have been reported though some are not proven convincingly. This case addresses all the issues raised in previous case reports and proves by clinical, laboratory, functional imaging and immunohistochemical analysis that ectopic origin of insulin by non-pancreatic tumors does occur. To our knowledge, this is the first reported case of ectopic insulinoma arising from the kidney.

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Causes and Evaluation of Tumor-Induced Hypoglycemia

Abstract: \s=b\We treated four patients who had hypoglycemia and non\x=req-\ pancreatic tumors. Two had pleural mesothelioma, one had primary fibrosarcoma of the liver, and one had pheochromocytoma metastatic to the liver. We propose four mechanisms for

Cited by 14 publications

References 20 publications

Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia

Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia

IGF-II Producing Hepatic Fibrosarcoma Associated with Hypoglycemia.

Ectopic insulin secreting neuroendocrine tumor of kidney with recurrent hypoglycemia: a diagnostic dilemma

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