Dose-related effects of growth hormone on IGF-I and IGF-binding protein-3 levels in non-islet cell tumour hypoglycaemia

Abstract

Mesenchymal tumours are a well recognised cause of spontaneous hypoglycaemia. The mechanism is thought to relate to hypersecretion by tumour cells of high molecular mass insulin-like growth factor-II (pro-IGF-II), with consequent suppression of growth hormone (GH) secretion. The use of recombinant human (rh)GH has been reported to alleviate hypoglycaemia in non-islet cell tumour hypoglycaemia, and the mechanism is thought to relate to GH-mediated increments in serum levels of IGF-binding protein-3 (IGFBP-3), thereby reducing the bioavailability of IGF-II. We report the effect of increasing doses of rhGH on the clinical condition and serum IGF-I and IGFBP-3 levels in two patients with solitary pleural fibrous tumours causing severe hypoglycaemia. Hypoglycaemia was successfully alleviated in each patient although, despite using large doses of rhGH, the observed increments in IGFBP-3 were only modest. We postulate that the beneficial effects of rhGH in this situation are likely to be multifactorial and not simply related to increments in serum IGFBP-3 levels.

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

“…reported the use of rhGH in two patients with pleural masses who both continued to experience hypoglycemia despite several attempted treatments. Both patients improved when treatment with rhGH was initiated [4]. The glucose levels stabilized on 6 and 8 mg daily of rhGH daily [4].…”

“…Both patients improved when treatment with rhGH was initiated [4]. The glucose levels stabilized on 6 and 8 mg daily of rhGH daily [4]. Others reported the use of up to 12 mg of rhGH daily for treatment of malignancy-induced hypoglycemia [5].…”

“…Given the high severity and life-threatening nature of his hypoglycemic episodes, he was started on rhGH 3.0 mg once daily. To achieve a better effect the rhGH was increased to 2.0 mg twice daily then to 4.0 mg twice daily, a dose previously reported in the literature [4]. The patient's hypoglycemia significantly improved after initiation of rhGH ( Figure 1).…”

“…Unlike glucocorticoids, experts recommend limiting the use of rhGH within the realm of palliation, in end-stage cancers, due to its potential for accelerating tumor growth. Few case reports have been published on the use of rhGH in NICTH, the majority of which have been reported in palliative care settings [4,5]. Herein, we report the successful use of rhGH, outside of the conventional palliation window, in treating severe and refractory NICTH, without altering the patient's oncological outcome.…”

Hypoglycemia Associated with Big Insulin-Like Growth Factor II Produced during Development of Malignant Fibrous Histiocytoma

“…Therapy with either GH, glucagon, glucocorticoids or somatostatin has been shown to be effective in individual patients with unresectable tumors. The use of recombinant human GH has been reported to alleviate hypoglycemia in NICTH [9], by increasing serum levels of IGFBP-3, and thereby reducing the bioavailability of IGF-II.…”