title: Hypoglycemia attributable to insulin-like growth factor-II prohormone-producing metastatic leiomyosarcoma.
abstract: OBJECTIVE
  To review the causes of nonpancreatic tumor-associated hypoglycemia and report the first case of hypoglycemia attributable to a leiomyosarcoma, which did not cause hypoglycemia in its primary site but only after metastasizing.
  
  
  METHODS
  A case report is presented of a 62-year-old man with a gastric leiomyosarcoma diagnosed and surgically treated 8 years previously, who was found to have 14 large, rounded masses in his liver and a blood glucose level of 19 mg/dL. Biopsy of the largest mass revealed a leiomyosarcoma.
  
  
  RESULTS
  Evaluation of the cause of the hypoglycemia revealed that circulating insulin, connecting peptide, proinsulin, insulin-like growth factor-I (somatomedin C), and insulin-like growth factor-II levels were below normal, whereas the insulin-like growth factor-II prohormone concentration was increased twofold. Basal and corticotropin-stimulated serum cortisol values were normal.
  
  
  CONCLUSIONS
  This is the first case report of hypoglycemia occurring only after metastasis of a leiomyosarcoma. A possible causal relationship between the hypoglycemia and the increased circulating insulin-like growth factor-II prohormone is suggested, and alternative explanations and treatment are discussed.
authors.affiliation: Department of Medicine, Physiology, and Biophysics, University of South Florida for Health Sciences, and J. A. Haley Veterans Hospital, Tampa, Florida, USA.
authors.forename: M
authors.initials: M
authors.lastname: Baig
authors.forename: R L
authors.initials: RL
authors.lastname: Hintz
authors.forename: B K
authors.initials: BK
authors.lastname: Baker
authors.forename: D L
authors.initials: DL
authors.lastname: Vesely