Clinical features of insulin-like growth factor-II producing non-islet-cell tumor hypoglycemia.
In some patients with non-islet-cell tumor hypoglycemia (NICTH), a high molecular weight form of IGF-II (big IGF-II) derived from tumors is present in the circulation and might be associated with recurrent hypoglycemia. In this study, in order to survey the clinical characteristics of patients with IGF-II producing NICTH, we analyzed the medical records of 78 patients with NICTH (M/F 44/34, age 62+/-1.8, range; 9-86 years.) whose serum contained a large amount of big IGF-II. Hepatocellular carcinoma and gastric carcinoma were the most common causes of NICTH. The diameters of the tumors were more than 10 cm in 70% of the patients. Basal immunoreactive insulin (IRI) levels were less than 3 microU/dl in 79% of the patients. Hypoglycemic attack was the onset of disease in 31 of 65 cases (48%), but the tumor was revealed prior to the occurrence of hypoglycemia in 34 cases (52%). Twenty-five of 47 (53%) patients had decreased serum potassium levels. These data suggested that hypoinsulinemic hypoglycemia associated with the presence of a large tumor supports the diagnosis of IGF-II producing NICTH. Hypokalemia was associated with hypoglycemia in some patients. The BMI (21.4+/-0.6 kg/m2) and serum total protein levels (6.6+/-0.1g/dl) were preserved at the occurrence of first hypoglycemic attack suggesting that malnutrition might not be the main cause of hypoglycemia in most patients.
Fukuda
Izumi
I
Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical University, Tokyo, Japan.
Hizuka
Naomi
N
Ishikawa
Yukiko
Y
Yasumoto
Kumiko
K
Murakami
Yuko
Y
Sata
Akira
A
Morita
Junko
J
Kurimoto
Makiko
M
Okubo
Yumiko
Y
Takano
Kazue
K
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D001943:Breast Neoplasms / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000378:metabolism; D002292:Carcinoma, Renal Cell / Q000378:metabolism; D002648:Child; D005260:Female; D005354:Fibrosarcoma / Q000378:metabolism; D046152:Gastrointestinal Stromal Tumors / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007335:Insulin-Like Growth Factor II; D007890:Leiomyosarcoma / Q000378:metabolism; D008113:Liver Neoplasms / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000378:metabolism* / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000378:metabolism; D010673:Pheochromocytoma / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000378:metabolism; D011506:Proteins / Q000378:metabolism*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000378:metabolism
D001786:Blood Glucose; C035170:IGF2 protein, human; D011506:Proteins; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II