Levels of glucose-regulatory hormones in patients with non-islet cell tumor hypoglycemia: including a review of the literature

Izumi, Fujio; Asai, Akira; Nagamine, Tomoko; Harada, Taro; Tanimura-Inagaki, Kyoko; Hizuka, Naomi; Sugihara, Hitoshi

doi:10.1507/endocrj.ej17-0072

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…All of these horses had neurologic abnormalities (obtundation N = 6/7, seizures N = 4/7). Possible causes for hypoglycemia in these horses could have included intermittent or persistent secretion of insulin growth‐like factor by non‐islet cell tumors (non‐islet cell tumor‐induced hypoglycemia [NICTH]) and paraneoplastic hypoglycemia as described in humans . Concentrations of insulin‐growth factors I and II for the documentation of NICTH was not performed in these horses…”

Section: Discussionmentioning

confidence: 99%

Presumed Neuroglycopenia Caused by Severe Hypoglycemia in Horses

Aleman

Costa

Crowe

et al. 2018

Veterinary Internal Medicne

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BackgroundNeuroglycopenia refers to a shortage of glucose in the brain resulting in neuronal dysfunction and death if left untreated. Presumed neuroglycopenia has not been described in horses.ObjectiveTo report neurological signs in horses with presumed neuroglycopenia as the result of severe hypoglycemia.AnimalsNinety horses (hours to 28 years of age) diagnosed with hypoglycemia (blood glucose concentration < 75 mg/dL [< 4.2 mmol/L]).MethodsRetrospective study. Electronic medical records were searched. Signalment, history, complaint, clinical signs, laboratory findings including CSF analysis, electroencephalogram, clinical or definitive diagnosis, and outcome were recorded. Kruskal‐Wallis analysis of variance and logistic regression were used to investigate association between blood glucose concentration and data extracted. Statistical significance was set at P < 0.05.ResultsThirty‐eight and 52 horses had mild (50‐74 mg/dL [2.8‐4.1 mmol/L]), and severe hypoglycemia (< 50 mg/dL [< 2.8 mmol/L]), respectively. Most common causes of hypoglycemia included liver and gastrointestinal (40%) disease, sepsis (33%), neoplasia (7%), and insulin‐induced (4%). Most common neurologic deficits included obtundation (100%), seizures (42%), and disorientation (22%). CSF‐glucose was severely low (mean 2.5 mg/dL [0.1 mmol/L], median 0 mg/dL). Paroxysmal discharges in support of seizures were identified in the occipital (visual) and parietal (closest to temporal‐auditory) cortical regions upon EEG examination (8/8 horses).Conclusions and clinical importanceNeuroglycopenia is presumed to occur in horses as the result of severe hypoglycemia. Subclinical seizures, and intermittent blindness and deafness of cortical origin can occur. Severe altered state of consciousness and seizures can be observed at a blood glucose cut‐off value of < 42 mg/dL (< 2.3 mmol/L).

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Section: Discussionmentioning

confidence: 99%

Presumed Neuroglycopenia Caused by Severe Hypoglycemia in Horses

Aleman

Costa

Crowe

et al. 2018

Veterinary Internal Medicne

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“…In some cases, patients experience severe hypoglycemia, and intensive treatments such as continuous glucose injections are needed. One of the mechanisms of NICTH is thought to be an excessive production of the high molecular weight form of IGF-II by tumors [3, 8]. In cases of NICTH, it is thought that within tumor cells, the enzymatic processing of pro IGF-II into mature IGF-II is somehow not performed normally.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of NICTH, it is thought that within tumor cells, the enzymatic processing of pro IGF-II into mature IGF-II is somehow not performed normally. Therefore, tumors secrete incompletely processed pro IGF-II as a high molecular weight form of IGF-II [8].…”

Section: Discussionmentioning

confidence: 99%

Splenic cord capillary hemangioma with non-islet cell tumor hypoglycemia: a case report

Daimon

Kosaka

Horinaga³

et al. 2019

Diagn Pathol

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BackgroundSplenic cord capillary hemangioma is a rare benign vascular lesion classified as a splenic hamartoma. On the other hand, non-islet cell tumor hypoglycemia (NICTH) is one of the rare causes of spontaneous hypoglycemia and is considered to be one of the paraneoplastic syndromes. To the best of our knowledge, this is the first reported case of a splenic cord capillary hemangioma with NICTH.Case presentationA 25-year-old male was referred to our hospital with hypoglycemia. Except for his low blood sugar, there were no abnormal findings from laboratory tests, which included an endocrinological examination. Enhanced computed tomography confirmed the presence of a solid mass measuring about 6 cm in the retroperitoneum, and a tumorectomy was performed. During this operation, it became clear that the tumor turned out to be a splenic parenchyma, and as a result, a total splenectomy was performed. Microscopically, we diagnosed this as a cord capillary hemangioma, and through immunohistochemistry, we found that some tumor cells were positive for insulin-like growth factor -II. Fortunately, the hypoglycemia-related symptoms disappeared after surgical resection was performed. The patient is still alive and well without evidence of local tumor recurrence 15 years after the operation.ConclusionsSplenic cord capillary hemangioma, one of the types of splenic hamartomas, is a very rare benign vascular lesion and might be associated with hypoglycemia thought to be NICTH.

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“…Increasing free IGF II concentration causes hypoglycaemia through the activation of IGF I receptors or insulin receptors. Although IGF II has low affinity to insulin receptors (at least 100-fold lower than insulin), its high concentration may activate a high enough number of receptors to cause a biological action similar to insulin [54]. In addition, cytokines produced by tumour cells: interleukins 6 and 1 (IL-6, IL-1), and tumour necrosis factor (TNF) can cause hypoglycaemia and weight loss.…”

Section: Hypoglycaemia In Cancermentioning

confidence: 99%

“…Zwiększenie stężenia wolnego IGF-2 powoduje hipoglikemię poprzez aktywację receptorów dla IGF-1 lub receptorów insulinowych. Chociaż IGF-2 ma małe powinowactwo do receptorów insulinowych (co najmniej 100-krotnie mniejsze niż insulina), to przy dużym stężeniu może aktywować dostateczną ich liczbę, aby spowodować biologiczne działanie podobne do działania insuliny [54]. Dodatkowo cytokiny produkowane przez komórki guza: interleukiny 6 i 1 (IL-6, IL-1) i czynnik martwicy nowotworu (TNF, tumour necrosis factor) mogą powodować hipoglikemię i wpływać na utratę masy ciała.…”

Section: Reviewunclassified

Hypoglycaemia in endocrine, diabetic, and internal diseases [Hipoglikemia w schorzeniach endokrynologicznych, diabetologicznych i internistycznych]

Rokicka

Marek

Kajdaniuk

et al. 2019

Endokrynologia Polska

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Hypoglycaemia is a decrease in blood glucose concentration below the physiological level. It occurs in healthy people and in people with various diseases with inadequate secretion of insulin by b cells, or deficiency of counterregulatory hormones secreted at the moment of hypoglycaemia. Hypoglycaemia is also associated with diabetes therapy, regardless of whether behavioural therapy, oral hypoglycaemic agents, or insulin are used. Distinguishing the causes of hypoglycaemia is the basis for taking appropriate therapeutic actions that protect patients against subsequent episodes of lowering blood glucose and complications caused by hypoglycaemia.

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Levels of glucose-regulatory hormones in patients with non-islet cell tumor hypoglycemia: including a review of the literature

Cited by 14 publications

References 21 publications

Presumed Neuroglycopenia Caused by Severe Hypoglycemia in Horses

Presumed Neuroglycopenia Caused by Severe Hypoglycemia in Horses

Splenic cord capillary hemangioma with non-islet cell tumor hypoglycemia: a case report

Hypoglycaemia in endocrine, diabetic, and internal diseases [Hipoglikemia w schorzeniach endokrynologicznych, diabetologicznych i internistycznych]

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