Malignant hypoglycemia associated with a large mesenchymal tumor: case report and review of the literature.
OBJECTIVE
To examine hypoglycemia associated with a non-islet-cell tumor caused by the secretion of abnormal insulinlike growth factors.


METHODS
We describe a 54-year-old woman with a massive solitary fibrous tumor who experienced worsening hypoglycemia with suppressed levels of insulin and insulinlike growth factor I but abnormally "normal" levels of insulinlike growth factor II.


RESULTS
Efforts to control her symptoms with frequent meals, prednisone, and intravenous dextrose infusions were only partially successful. Attempts at reducing the tumor size by embolizing its arterial supply and percutaneous alcohol injections were unsuccessful, and the patient died 24 hours after surgical debulking.


CONCLUSIONS
Patients with non-islet-cell tumor hypoglycemia usually have abnormally high levels of an incompletely processed precursor of insulinlike growth factor II, which is more bioavailable than the normal molecule. In some patients, treatment with corticosteroids and growth hormone increases blood sugar levels, but the most effective therapeutic approach is to resect or debulk the tumor.
Rose
M G
MG
Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA.
Tallini
G
G
Pollak
J
J
Murren
J
J
D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000628:therapy; D008637:Mesenchymoma / Q000097:blood / Q000150:complications* / Q000628:therapy; D013960:Thyroid Function Tests