title: Lactic acidosis and hypoglycemia in a patient with high-grade non-Hodgkin's lymphoma and elevated circulating TNF-alpha.
abstract: A 71-year-old patient with high-grade non-Hodgkin's lymphoma stage IVB, severe lactic acidosis and tumor-associated hypoglycemia is described. Endocrine causes of hypoglycemic episodes were excluded because of low serum concentrations of insulin and "insulin-like growth factor 1", and normal concentrations of growth hormone and thyroid hormone. Clinical conditions associated with lactic acidosis such as diabetes mellitus, biguanide intoxication, septicemia, acute hypoxemia, or circulatory insufficiency were ruled out. Enhanced glucose metabolism within the tumor was visualized by positron emission tomography employing 2-fluro-2-deoxy-D-glucose (FDG) as a tracer. A markedly elevated tumor necrosis factor-alpha (TNF-alpha) level was found which decreased after cytoreductive therapy paralleling the normalization of serum lactate. In contrast to the majority of cases of lymphoma-associated lactic acidoses reviewed to date, in our case lactate elimination was not reduced.
authors.affiliation: Department of Medical Oncology and Hematology, University Hospital, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Durig
authors.forename: W
authors.initials: W
authors.lastname: Fiedler
authors.forename: M
authors.initials: M
authors.lastname: de Wit
authors.forename: M
authors.initials: M
authors.lastname: Steffen
authors.forename: D K
authors.initials: DK
authors.lastname: Hossfeld
mesh_terms: D000140:Acidosis, Lactic / Q000000981:diagnostic imaging / Q000209:etiology*; D000368:Aged; D003847:Deoxyglucose / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D017809:Fatal Outcome; D005260:Female; D019788:Fluorodeoxyglucose F18; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007003:Hypoglycemia / Q000000981:diagnostic imaging / Q000209:etiology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism; D009363:Neoplasm Proteins / Q000097:blood; D010386:Pelvic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism; D014055:Tomography, Emission-Computed; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000502:physiology
chemical_list: D009363:Neoplasm Proteins; D014409:Tumor Necrosis Factor-alpha; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose