Nonislet Cell Tumor Hypoglycemia

Abstract

Nonislet cell tumor hypoglycemia (NICTH) is a rare cause of hypoglycemia. It is characterized by increased glucose utilization by tissues mediated by a tumor resulting in hypoglycemia. NICTH is usually seen in large mesenchymal tumors including tumors involving the GI tract. Here we will discuss a case, its pathophysiology, and recent advances in the management of NICTH. Our patient was diagnosed with poorly differentiated squamous cell carcinoma of esophagus. He continued to be hypoglycemic even after starting continuous tube feeds and D5W. General workup for hypoglycemia was negative and insulin-like growth factor II (IGF II) was in the normal range. Hypoglycemia secondary to “big” IGF II was considered, and patient was started on steroids. His hypoglycemia resolved within a day of treatment with steroids. Initially patient had hypoglycemia unawareness, which he regained after maintaining euglycemia for 48 hours.

Hypoglycemia associated with disseminated metastatic tonsillar squamous cell carcinoma producing insulin‐like growth factor‐I in a Pomeranian dog

“…To our knowledge, paraneoplastic hypoglycemia associated with squamous cell carcinoma has not been reported in dogs. In humans, there have been a few case reports of hypoglycemia associated with squamous cell carcinoma . Nonislet cell tumors may induce hypoglycemia by increased tumor utilization of glucose, decreased hepatic glycogenolysis or gluconeogenesis, and/or the secretion of insulin or IGF‐I and IGF‐II .…”

“…Although serum IGF‐I and IGF‐II concentrations were not evaluated due to the lack of commercially available and validated methods for use in dogs, an IGF‐I–secreting carcinoma resulting in persistent hypoglycemia is highly suggestive in this case, given the presence of positive IGF‐I expression on immunohistochemistry. In a human report, of 44 patients with hypoglycemia due to an IGF‐II–secreting tumor, 31 had increased “big IGF‐II” production and only 13 patients had increased IGF‐II production . Measuring “big IGF‐II” is difficult because there is no readily available test.…”

A 94-Year-Old Man with Recurrent Hypoglycemia Caused by Non-Islet Cell Tumor Hypoglycemia ( NICTH )

“…However, the major cause of NICTH appears to be increased glucose utilization (particularly in the skeletal muscle) and inhibition of glucose releasefrom the liver, which is caused by tumoral secretion of incompletely processed insulin-like growth factor (IGF)-II, (termed "big" IGF-II) ( 7 ) acting through the insulin receptor, or, rarely, IGF-I.Big IGF-II also suppresses glucagon and growth hormone release. (7) The net result is continued glucose utilization by skeletal muscle and inhibition of glucose release, glycogenolysis, and gluconeogenesis in the liver. (7) Our case is one of only 290 cases of NICTH that have been reported in the English language medical literature in the past 25 years.…”

“…(7) The net result is continued glucose utilization by skeletal muscle and inhibition of glucose release, glycogenolysis, and gluconeogenesis in the liver. (7) Our case is one of only 290 cases of NICTH that have been reported in the English language medical literature in the past 25 years. (2) NICTH usually presents in the fifth to sixth decade of life andgenerally occurs between meals or in the morning, (4) with a mean duration of symptoms from weeks to months.…”

Hepatic Solitary Fibrous Tumor Presenting as Severe Hypoglycaemia: A Case-Report

“…Multiple possible etiologies have been described including islet and non-islet cell tumors, medications, alcohol, sepsis, organ failure and cortisol deficiency. Numerous tumor types have been associated with non-islet cell tumor hypoglycemia (NICTH) including tumors of mesenchymalor gastrointestinal origin [1]. Solitary fibrous tumors (SFTs) are rare neoplasms and are usually found in the thorax arising from the pleura.…”