A case report of non-islet cell tumour hypoglycaemia associated with ovarian germ-cell tumour

Powter, Louise; Phillips, Suzanne; Husbands, Emma

doi:10.1177/0269216312462273

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…They can be useful in treating hypoglycemia via reduction in IGF-2 levels [17]. However, several cases have been reported where glucocorticoids failed to treat NICTH, even with extremely high doses [18,19]. In a refractory setting, as was shown in this case, rhGH can be considered as well.…”

Section: Discussionmentioning

confidence: 81%

Growth hormone therapy in non-islet cell tumor mediated hypoglycemia associated with metastatic lung adenocarcinoma

Ca¹,

Tsm²,

Fa³

et al. 2017

Clin Med Invest

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Severe hypoglycemia is a rare but serious sequela of malignancy. It may be seen with either islet or non-islet cell tumors. Treatment of non-islet cell tumor mediated hypoglycemia (NICTH) is often challenging, especially when rapid tumor debulking is not feasible. Medical therapies with glucocorticoids and enteral feeds have been utilized in the past, but with limited success. The use of recombinant human growth hormone (rhGH) in cases of NICTH, although seemingly effective, has been limited to end-stage cancers, due to its potential for accelerating tumor growth. Here, we report the successful use of rhGH in severe and refractory NICTH, in a patient with non-operable metastatic lung adenocarcinoma, without altering the patient's oncological outcome.

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Section: Discussionmentioning

confidence: 81%

Growth hormone therapy in non-islet cell tumor mediated hypoglycemia associated with metastatic lung adenocarcinoma

Ca¹,

Tsm²,

Fa³

et al. 2017

Clin Med Invest

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“…Prior reports indicate that this is a rare event, with hypercalcemia and hypoglycemia often predicting imminent death (13,15,17,18).…”

Section: Discussionmentioning

confidence: 99%

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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“…new-onset hypoglycemia may suggest the presence of a paraneoplastic syndrome related to tumours that secrete insulin, either pancreatic insulinomas or ectopic insulin-secreting tumours (29,5). Furthermore, tumours can secrete other substances that interfere with glucose metabolism, causing, for example, nonislet cell tumourinduced hypoglycemia (30). tumours secrete a high-molecular-weight precursor of insulin-like growth factor ii (iGF ii), which acts on insulin receptors to increase glucose uptake (30).…”

Section: Other Paraneoplastic Syndromes In a Palliative Care Settingmentioning

confidence: 99%

“…Furthermore, tumours can secrete other substances that interfere with glucose metabolism, causing, for example, nonislet cell tumourinduced hypoglycemia (30). tumours secrete a high-molecular-weight precursor of insulin-like growth factor ii (iGF ii), which acts on insulin receptors to increase glucose uptake (30). nonislet cell hypoglycemia occurs most commonly in patients with mesenchymal tumours, carcinoid tumours, myelomas, fibromas, lymphomas, hepatocellular tumours, and colorectal carcinomas.…”

Section: Other Paraneoplastic Syndromes In a Palliative Care Settingmentioning

confidence: 99%

“…nonislet cell hypoglycemia occurs most commonly in patients with mesenchymal tumours, carcinoid tumours, myelomas, fibromas, lymphomas, hepatocellular tumours, and colorectal carcinomas. treatment involves removal or reduction of the tumour mass and a combination of corticosteroid, human growth hormone, and somatostatin analogues (5,29,30). Malignant insulin-secreting tumours often grow very slowly, and -providing hypoglycemia can be avoided through the use of antihypoglycemic therapy and/or ablation of the primary tumour and metastases -many good years of life may remain to the patient (29).…”

Section: Other Paraneoplastic Syndromes In a Palliative Care Settingmentioning

confidence: 99%

See 1 more Smart Citation

Paraneoplastic Syndromes in Palliative Care: A literature review from a nursing perspective

Johnson

2015

J Palliat Care

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A case report of non-islet cell tumour hypoglycaemia associated with ovarian germ-cell tumour

Abstract: This case illustrates the need for awareness among general physicians of rare tumour manifestations and the need for multidisciplinary input for the optimal management of these patients.

Cited by 9 publications

References 11 publications

Growth hormone therapy in non-islet cell tumor mediated hypoglycemia associated with metastatic lung adenocarcinoma

Growth hormone therapy in non-islet cell tumor mediated hypoglycemia associated with metastatic lung adenocarcinoma

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

Paraneoplastic Syndromes in Palliative Care: A literature review from a nursing perspective

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