The role of glucagon administration in the diagnosis and treatment of patients with tumor hypoglycemia

Abstract

The glucagon stimulation test is a simple and fast approach that serves to clarify the etiology of hypoglycemia (diagnostic use) and guide effective long term strategies for its control (therapeutic use) in patients with neoplastic diseases and liver metastases.

Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment

“…4 The clinical features, associated malignancies, diagnostic studies, and treatment options of paraneoplastic endocrine syndromes are listed in Table 1. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Syndrome of InapproprIate antIdIuretIc Hormone SecretIon The syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is characterized by hypo-osmotic, euvolemic hyponatremia, affects 1% to 2% of all patients with cancer. Small cell lung cancer accounts for most of these cases, with approximately 10% to 45% of all patients with small cell lung cancer developing SIADH.…”

“…For recurrent or chronic hypoglycemic episodes, longer-term management includes corticosteroids, growth hormone, diazoxide, octreotide, or glucagon. [15][16][17] Diazoxide, which inhibits insulin secretion by pancreatic β cells, has been used primarily in the management of islet cell tumor hypoglycemia. 17,26 It is also approved for the treatment of hypoglycemia due to hyperinsulinism associated with extrapancreatic malignancies.…”

“…[15][16][17] Diazoxide, which inhibits insulin secretion by pancreatic β cells, has been used primarily in the management of islet cell tumor hypoglycemia. 17,26 It is also approved for the treatment of hypoglycemia due to hyperinsulinism associated with extrapancreatic malignancies. Because octreotide has been associated with worsening hypoglycemia in some patients, 15 is recommended.…”

“…Glucagon requires adequate hepatic glycogen stores, which may be assessed with a 1-mg IV glucagon challenge. 17 …”

Hypoglycaemia presenting as sole manifestation of hepatocellular carcinoma

“…Good glucose response to glucagon occurs in case of insulinoma. 7 Hypoglycaemia disappears with definitive treatment of non-islet cell neoplasm. Control of hypoglycaemia by percutaneous ethanol injection therapy to the HCC has been reported from some centres.…”