Non islet cell tumor hypoglycaemia in a metastatic Leydig cell tumor.
Non islet cell tumour hypoglycaemia (NICTH) is a rare cause of hypoglycaemia associated with malignancy and can be considered as a paraneoplastic syndrome. The hormonal factor associated with this condition is big IGF II, which exerts negative feedback effect and decreases the production of growth hormone and insulin. Due to low growth hormone levels, hepatic production of IGFBP 3 (the main binding protein of IGF II) is impaired. Excess free big IGF II is thus available for binding with insulin receptors to cause hypoglycaemia. Treatment options are either surgical removal of the tumour, administration of growth hormone, glucocorticoids or combination of treatments. A case of metastatic Leydig cell tumour causing NICTH has been discussed and the mechanism of NICTH hypoglycaemia and the treatment is outlined.
Mukherjee
Sagarika
S
Department of Diabetes and Endocrinology, University Hospital of Wales, Cardiff, Wales, UK. sagarsankar@hotmail.com
Diver
M
M
Weston
P J
PJ
D000368:Aged; D002096:C-Peptide / Q000097:blood; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D007328:Insulin / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D007984:Leydig Cell Tumor / Q000097:blood / Q000188:drug therapy / Q000556:secondary*; D008297:Male; D010190:Pancreatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy / Q000556:secondary*
D002096:C-Peptide; D005938:Glucocorticoids; D007328:Insulin; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II