ABSTRACT
We report the case of a 75-year-old man who was admitted to the hospital with symptoms of severe hypoglycemia. He had a history of solitary fibrous tumor diagnosed by Pathology after its complete surgical resection eight years before. The laboratory examination reported hypoglycemia with inhibited Insulin secretion. A computed tomography of the thorax revealed a large solid heterogeneous mass in the left hemithorax. Solitary fibrous tumor is a rare neoplasm. The association of solitary fibrous tumor and paraneoplastic hypoglycemia is known as Doege-Potter syndrome and occurs in less than 5% of all solitary fibrous tumors.
Subject(s)
Humans , Male , Female , Aged , Paraneoplastic Syndromes/etiology , Solitary Fibrous Tumor, Pleural/complications , Hypoglycemia/etiology , Paraneoplastic Syndromes/diagnostic imaging , Tomography, X-Ray Computed , Solitary Fibrous Tumor, Pleural/diagnostic imaging , Hypoglycemia/diagnostic imagingABSTRACT
A patient with severe hypoglycemia due to insulin-like growth factor ( IGF)-IIsecreted by a giant solitary fibrous tumor of the pleura ( SFTP) was investigated through comprehensively reviewing his medical history and clinical records. The patient had severe hypoglycemia accompanied with significantly decreased serum insulin level. A solitary fibrous tumor of the pleura was found, and right pneumonectomy removed this giant tumor. Two years after the operation, the patient was fit and well with no further hypoglycemia episodes. Non-islet-cell tumor hypoglycemia should be considered in patients who have hypoglycemia episodes accompanied with significantly decreased serum insulin level.
ABSTRACT
Mesenchymal tumors including hemangiopericytomas, hepatocellular tumors, adrenal carcinomas, and a variety of other large tumors have been reported to produce excessive amounts of insulin-like growth factor (IGF) type II precursor, which binds weakly to insulin receptors and strongly to IGF-I receptors, leading to insulin like actions. In addition to increased IGF-II production, IGF-II bioavailability is increased due to complex alterations in circulating binding proteins. The authors of this article diagnosed non-islet cell tumor hypoglycemia from an 81-year-old male patient suffering from repetitive fasting hypoglycemia while he has not received any treatment for pulmonary hemangiopericytoma diagnosed in the past. Moreover, this topic is getting reported as the authors have experienced a significant improvement of catamnesis by a treatment with glucocorticoid.
Subject(s)
Aged, 80 and over , Humans , Male , Biological Availability , Carrier Proteins , Hemangiopericytoma , Hypoglycemia , Insulin , Insulin-Like Growth Factor I , Insulin-Like Growth Factor II , Receptor, IGF Type 1 , Receptor, InsulinABSTRACT
Hypoglycemia due to non-islet cell tumor is usually associated with hypersecretion of big insulin-like growth factor II (IGF-II). This big IGF-II cannot form ternary IGF complex, and is biologically more active in peripheral tissue, inducing increased glucose utilization and hypoglycemia. A 57-year-old man developed severe hypoglycemia due to hepatocellular carcinoma. To control hypoglycemia, the patient required continuous glucose infusion. The circulating levels of cortisol and free T4 were in the normal range. The plasma levels of insulin, C-peptide, IGF-I, IGF binding protein-3 (IGFBP-3), and total IGF-II levels were decreased. Radioimmunoassay of IGF-II revealed that big IGF-II immunoreactivity markedly increased compared to that of normal control. In this patient, it was strongly suggested that big IGF-II might be a cause of severe intractable hypoglycemia.
Subject(s)
Humans , Middle Aged , C-Peptide , Carcinoma, Hepatocellular , Glucose , Hydrocortisone , Hypoglycemia , Insulin , Insulin-Like Growth Factor I , Insulin-Like Growth Factor II , Plasma , Radioimmunoassay , Reference ValuesABSTRACT
The relationship between abnormal circulating GH-insulin-like growth factor (IGF) axis and hypoglycaemia was explored in 2 cases of non-islet cell tumor associated hypoglycaemia (NICTH). Serum level of IGF-Ⅱ was increased, the levels of GH, IGF-Ⅰ, IGFBP-3 were decreased to some extent, and IGF-Ⅱ/IGF-Ⅰ (molar ratio) was significantly increased in these two cases. In one case, circulating GH-IGF axis returned to normal after complete removal of the tumor. In the diagnosis of NICTH, the abnormal circulating GH-IGF axis is quite valuable and IGF-Ⅱ/IGF-Ⅰ appears to be a more sensitive parameter.