The effectiveness of different treatment options for non-islet cell tumour hypoglycaemia.
OBJECTIVE
To compare the outcome of different treatment options used in several cases of non-islet cell tumour hypoglycaemia (NICTH).


METHODS
Eight cases of NICTH were referred for diagnosis and monitoring following either surgical or medical treatment.


METHODS
Serum samples collected throughout the time-course of each case were analysed for glucose, insulin, C-peptide, IGF-I, total IGF-II, total IGF-II to IGF-I ratio and, in most of the cases, big IGF-II.


RESULTS
Surgical excision was successful in the relief of symptoms and normalization of the biochemical parameters. Therapeutic treatment with glucocorticoids confirmed previous studies showing the suppressive effect on tumour (big) IGF-II production. The present data show that the effect was dose-dependent and reversible if doses were below a critical level.


CONCLUSIONS
Within the limits of the cases studied, and the time-scales involved, moderate- to high-dose glucocorticoid therapy had immediate beneficial influence on symptomatic hypoglycaemia and, if tolerated in the long term, was effective in correcting the underlying biochemical dysfunction, unlike other therapeutic regimens. This effectiveness was only achieved when the dose exceeded a threshold level specific to the patient. In addition, reduction of the dose or withdrawal of the drug caused a return of the abnormal biochemical profile. Surgical removal of the malignancy, where this was an option, was successful within the periods studied.
Teale
J D
JD
Supraregional Hormone Centre, Clinical Laboratory, Royal Surrey County Hospital, Guildford, Surrey, UK. dteale@royalsurrey.nhs.uk
Wark
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D007328:Insulin / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007335:Insulin-Like Growth Factor II / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D011498:Protein Precursors / Q000032:analysis
D001786:Blood Glucose; D002096:C-Peptide; D005938:Glucocorticoids; D007328:Insulin; D011498:Protein Precursors; C066038:proinsulin-like growth factor II; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II; D011239:Prednisolone