Hypoglycemia associated with non-islet cell tumors

Kantarova, D; Sagova, Ivana; Stancik, M; Sadloňová, Jurina

doi:10.4149/neo_2015_102

Cited by 7 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seborrheic Keratosi, hypokalemia, hyperkalemia, Pierre Mary hypertrophic arthropathy, and hypoglycemia have all been reported as syndromes associated with benign and malignant SFTs [14]. Notably, although pleural SFTs are now regarded as the second most common cause of paraneoplastic hypoglycemia, referred to as Doege-Potter Syndrome (DPS), only 5% of all of cases reporting SFT thus far have been associated with spontaneous hypoglycemia [15]. In a study by Meng et al .…”

Section: Discussionmentioning

confidence: 99%

A Rare Diagnosis After the Fall of a 96-Year-Old Woman: Doege-Potter Syndrome

Pincelli

Perotti

Massariello

et al. 2019

CAS

View full text Add to dashboard Cite

Introduction: Doege-Potter Syndrome (DPS) is a rare but life-threatening paraneoplastic syndrome, characterized by Non-Islet Cell Tumor-Induced Hypoglycemia (NICTH) secondary to a Solitary Fibrous Tumor (SFT), which secretes an incompletely processed form of Insulin-like Growth Factor 2 (IGF-2). Results: A 96-year-old woman was admitted with head trauma due to an accidental fall. During her hospital stay she experienced frequent hypoglycemic episodes. Multiple injections of 33% dextrose and continuous infusion with 10% dextrose were required to maintain normal blood glucose levels. Biochemical analyses revealed hypoinsulinemic hypoglycemia, low C-peptide levels, suppressed in-sulin-like growth factor-1, normal insulin-like growth factor-2, and an elevated IGF-2:IGF-1 ratio, all consistent with IGF-2 secretion by a non-islet cell tumor. A contrast-enhanced chest and abdominal CT scans showed a single large pleural mass in the left lower hemithorax measuring 15x14 cm without secondary lesions. Histological analysis of biopsied specimens suggested a solitary fibrous pleural tumor; accordingly, a diagnosis of Doege-Potter syn-drome was considered. Due to extensive tumor burden and the advanced age of the patient, supportive and non-invasive management was chosen. Dexamethasone therapy was started, and while receiving this therapy she was able to discontinue glucose infusion and successfully maintain euglycemia. Discussion: In the elderly, a sudden and unexplained fall can be the expression of severe hypogly-cemia, usually as a complication of insulin therapy or of oral hypoglycemic agents administered to pa-tients with diabetes. However, in patients without diabetes, other causes should be investigated, and the hypothesis of neoplastic diseases should be considered. Conclusion: In this case report we describe an uncommon cause of paraneoplastic hypoglycemia oc-curring in the oldest patient with a non-islet cell tumor reported thus far.

show abstract

Section: Discussionmentioning

confidence: 99%

A Rare Diagnosis After the Fall of a 96-Year-Old Woman: Doege-Potter Syndrome

Pincelli

Perotti

Massariello

et al. 2019

CAS

View full text Add to dashboard Cite

show abstract

“…These tumors, also called non-islet cell tumors, are often caused by an increase in IGF-2, a peptide that activates the insulin receptor. 49 Ectopic insulin secretion has been reported in a few cases, but most have not been convincingly proven. 50 Nevertheless, extrapancreatic insulin-secreting neuroendocrine tumors with hyperinsulinemic hypoglycemia have been reported very rarely.…”

Section: Hypoglycemia Of Non-islet Cell Tumorsmentioning

confidence: 99%

“…High circulating IGF-2 activates the insulin receptor and causes hypoglycemia. 49 The clinical features of NICTH result from recurrent episodes of fasting hypoglycemia and tumor growth and spread. The diagnosis of NICTH includes low glucose levels (serum glucose <55 mg/dl) with concurrent low insulin/proinsulin/c-peptide/βhydroxybutyrate levels and the absence of positive results in screening for oral hypoglycemic agents.…”

Section: Hypoglycemia Of Non-islet Cell Tumorsmentioning

confidence: 99%

Non-diabetic hypoglycemia

Mete,

Cesur

2023

ICJIM

View full text Add to dashboard Cite

Glucose is the main substrate utilized by the brain, and therefore numerous counterregulatory mechanisms exist to maintain plasma glucose concentration. This makes it rare for hypoglycemia to develop in people who are not taking hypoglycemic drugs, such as insulin or sulfonylureas, for diabetes. The symptoms of hypoglycemia are nonspecific. The presence of Whipple’s triad is necessary for diagnosis. When symptoms occur spontaneously, the patient can be evaluated for hypoglycemia. If this is not possible, then a 72-hour fasting test or a mixed meal tolerance test can be performed to create conditions for symptoms to occur. Non-diabetic hypoglycemia is mainly divided into two main groups: insulin-mediated (hyperinsulinism) and insulin-independent. The main causes of hypoglycemia due to endogenous hyperinsulinism are insulinoma and islet cell hyperplasia (nesidioblastosis), post-bariatric surgery, and autoimmune hypoglycemia with the presence of anti-insulin antibodies. Other important causes of hypoglycemia include hypoglycemic drugs, non-islet cell tumors, hormonal deficiencies (primary adrenal insufficiency, anterior pituitary insufficiency), and critical illnesses (liver/kidney failure). In this article, we provide an overview of the pathogenesis and treatment of hypoglycemia.

show abstract

“…Feedback of big IGF-II on the hypothalamic-pituitary axis inhibits growth hormone (GH) secretion with subsequent lowering of GH-dependent IGF-I and IGF-binding proteins secreted by the liver. Tumours secreting big IGF-II are characterised by an increased total IGF-II:IGF-I ratio, hypoglycaemia with suppressed insulin and C-peptide and inappropriately low GH and β-OHB levels [62,63].…”

Section: Hypoinsulinaemic Hypoglycaemiamentioning

confidence: 99%

Investigation and Causes of Spontaneous (Non-Diabetic) Hypoglycaemia in Adults: Pitfalls to Avoid

Elghobashy,

Gama,

Sulaiman

2023

Diagnostics

View full text Add to dashboard Cite

Although adult spontaneous (non-diabetic) hypoglycaemia is rare, its recognition is important for the preventative or curative treatment of the underlying cause. Establishing Whipple’s triad—low blood glucose, neuroglycopaenia and resolution of neuroglycopaenia on increasing blood glucose levels to normal or above—is essential to verify hypoglycaemia. Awareness that hypoglycaemia may occur in severely ill patients is important for its prevention. Further investigation in such cases is unnecessary unless another cause of hypoglycaemia is suspected. Patients are often asymptomatic and normoglycaemic at review. Their history of medication, self-medication, access to hypoglycaemic drugs, alcohol use and comorbidity may provide aetiological clues. The investigation involves obtaining blood samples during symptoms for laboratory glucose measurement or provoking fasting or postprandial hypoglycaemia as directed by symptoms. If confirmed, insulin, c-peptide, proinsulin and beta-hydroxybutyrate are analysed in hypoglycaemic samples. These will classify hypoglycaemia due to non-ketotic hyperinsulinaemia, non-ketotic hypoinsulinaemia and ketotic hypoinsulinaemia, and direct investigations to identify the underlying cause. There are, however, many pitfalls that may mislabel healthy individuals as “hypoglycaemic” or misdiagnose treatable or preventable causes of spontaneous hypoglycaemia. Clinical acumen and appropriate investigations will mostly identify hypoglycaemia and its cause.

show abstract

Hypoglycemia associated with non-islet cell tumors

Abstract: tumor hypoglycemia, non-islet cell tumor, insulin-like growth factor.

Cited by 7 publications

References 13 publications

A Rare Diagnosis After the Fall of a 96-Year-Old Woman: Doege-Potter Syndrome

A Rare Diagnosis After the Fall of a 96-Year-Old Woman: Doege-Potter Syndrome

Non-diabetic hypoglycemia

Investigation and Causes of Spontaneous (Non-Diabetic) Hypoglycaemia in Adults: Pitfalls to Avoid

Contact Info

Product

Resources

About