The effectiveness of different treatment options for non‐islet cell tumour hypoglycaemia

Teale, J D; Wark, Gwen

doi:10.1111/j.1365-2265.2004.01989.x

Cited by 91 publications

(94 citation statements)

References 12 publications

(17 reference statements)

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“…ternary complex formation (3,12). Successful treatment of hypoglycemia has been described in several case reports and series, with response rates appearing to be dose dependent (3,(6)(7)(8)(9). Despite these positive responses, there are scattered reports of refractory hypoglycemia on high doses of glucocorticoids, as in our patient.…”

Section: Discussionmentioning

confidence: 65%

Refractory Hypoglycemia from Paraneoplastic Insulin-Like growth Factor 2 Secretion in A Patient with Hepatocellular Carcinoma

Behringer-Massera

Brutsaert

Epstein

2017

AACE Clinical Case Reports

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Objective: Hypoglycemia due to insulin-like growth factor (IGF)-2 secretion by a tumor, referred to as nonislet cell tumor hypoglycemia, or IGF-2-oma, is a rare and serious paraneoplastic complication of malignancy. When surgical resection is not an option, studies have shown improvement of hypoglycemia with glucocorticoids. We describe the case of a patient with persistent hypoglycemia despite prolonged high-dose glucocorticoid therapy.Methods: A 22-year-old man with known metastatic hepatocellular carcinoma presented with dizziness and weakness. Initial blood glucose level was found to be 10 mg/dL. Multiple injections of 50% dextrose and continuous infusion with 25% dextrose were required to maintain normal blood glucose levels. Laboratory work-up revealed suppressed C-peptide and insulin levels with hypoglycemia and an elevated ratio of IGF-2 to IGF-1, consistent with IGF-2 secretion by the tumor.Results: Despite high-dose glucocorticoid therapy, continuous intravenous dextrose was necessary to prevent hypoglycemia. In addition, the patient's tumor progressed rapidly, and he was ultimately discharged to hospice on intravenous dextrose. Conclusion CASE REPORTA 22-year-old man presented with nausea, vomiting, dizziness, and severe weakness for 1 day. Three weeks prior, he had been diagnosed with hepatocellular carcinoma with pulmonary metastases, secondary to chronic hepatitis B infection. In the emergency room, the patient was found to have a capillary blood glucose level of 10 mg/ dL, and he received multiple intravenous doses of 50 mL of 50% dextrose (50 mg/mL). Despite these treatments, he was unable to sustain euglycemia, and continuous dextrose 25% (250 mg/mL) infusion was started. On physical examination, he appeared cachectic, with lower extremity edema, exquisite right upper-quadrant abdominal tenderness, and hepatomegaly. Initial laboratory tests were significant for serum glucose 10 mg/dL, serum calcium of 12.4 mg/dL (corrected for albumin, 13

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Section: Discussionmentioning

confidence: 65%

Refractory Hypoglycemia from Paraneoplastic Insulin-Like growth Factor 2 Secretion in A Patient with Hepatocellular Carcinoma

Behringer-Massera

Brutsaert

Epstein

2017

AACE Clinical Case Reports

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“…Thereafter, the dose of prednisolone was tapered to 15 mg/day, but his blood glucose levels were stable and hypoglycemia no longer occurred. (2,9,10 (4,5,8,11,12) (4,5,13). Surgical resection led to normalization of the plasma glucose levels in all five cases.…”

Section: F I G U R E 4 Cl I N I C a L C O U R S E Hy P O G L Y C mentioning

confidence: 78%

“…Interestingly, five of six cases treated with glucocorticoid therapy no longer suffered from hypoglycemic attacks in spite of receiving no anti-tumor treatment (16,17). On the other hand, three of four cases treated with dextrose infusion alone had repeated hypoglycemic episodes (18) (6,13,19). In addition, glucocorticoid may inhibit the tumor growth, because IGF-II is one of the autocrine growth factors for the tumor (20).…”

Section: F I G U R E 4 Cl I N I C a L C O U R S E Hy P O G L Y C mentioning

confidence: 99%

Glucocorticoid Therapy Ameliorated Hypoglycemia in Insulin-like Growth Factor-II-producing Solitary Fibrous Tumor

et al. 2006

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“…In a previous report, Teale et al reported that glucocorticoid therapy suppressed abnormal secretion of big-IGF-II in a case of NICTH (24). To understand the effect of glucocorticoid treatment, we must clarify the molecular changes in NICTH.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia Associated with a Gastrointestinal Stromal Tumor Producing High-molecular-weight Insulin Growth Factor II: A Case Report and Literature Review

et al. 2016

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A 61-year-old woman with multiple metastatic and unresectable gastrointestinal stromal tumors (GISTs) was referred for investigation of refractory hypoglycemia that developed four months before this hospitalization. On admission, her fasting plasma glucose was 38 mg/dL despite 10% glucose infusion. Investigations revealed that her serum C-peptide, insulin and growth hormone levels were suppressed, and big insulin-like growth factor II was observed. She was diagnosed with non-islet cell tumor hypoglycemia, which resolved after glucocorticoid treatment. Clinicians should thus be vigilant to identify hypoglycemia in patients with large metastatic GISTs because glucocorticoid therapy is useful even if the GIST is inoperable.

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The effectiveness of different treatment options for non‐islet cell tumour hypoglycaemia

Cited by 91 publications

References 12 publications

Refractory Hypoglycemia from Paraneoplastic Insulin-Like growth Factor 2 Secretion in A Patient with Hepatocellular Carcinoma

Refractory Hypoglycemia from Paraneoplastic Insulin-Like growth Factor 2 Secretion in A Patient with Hepatocellular Carcinoma

Glucocorticoid Therapy Ameliorated Hypoglycemia in Insulin-like Growth Factor-II-producing Solitary Fibrous Tumor

Hypoglycemia Associated with a Gastrointestinal Stromal Tumor Producing High-molecular-weight Insulin Growth Factor II: A Case Report and Literature Review

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