Refractory Hypoglycemia from Paraneoplastic Insulin-Like growth Factor 2 Secretion in A Patient with Hepatocellular Carcinoma
| Autor: | Erika F. Brutsaert, Stephanie Behringer-Massera, Eric J. Epstein |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty medicine.medical_treatment Hypoglycemia Malignancy Diseases of the endocrine glands. Clinical endocrinology 03 medical and health sciences 0302 clinical medicine Refractory Internal medicine medicine biology business.industry Insulin Growth factor General Medicine medicine.disease RC648-665 030104 developmental biology Endocrinology 030220 oncology & carcinogenesis Hepatocellular carcinoma Insulin-like growth factor 2 biology.protein business Complication |
| Zdroj: | AACE Clinical Case Reports, Vol 3, Iss 4, Pp 364-366 (2017) |
| ISSN: | 2376-0605 |
| Popis: | Objective: Hypoglycemia due to insulin-like growth factor (IGF)-2 secretion by a tumor, referred to as non–islet 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: Hypoglycemia due to IGF-2 secretion is a rare and challenging paraneoplastic complication. Cases of hypoglycemia that do not respond to glucocorticoid therapy may indicate rapid disease progression and imminent death.Abbreviation: IGF insulin-like growth factor |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|