Non-islet cell tumour-induced hypoglycaemia: a review of the literature including two new cases.
This review focuses on the tumour types and symptoms associated with non-islet cell tumour-induced hypoglycaemia (NICTH) as well as the pathogenesis, diagnosis and treatment of this rare paraneoplastic phenomenon. In addition, we report two illustrative cases of patients suffering from NICTH caused by a solid fibrous tumour and a haemangiopericytoma respectively. In the first case, NICTH resolved following complete resection of the tumour, but in the second case the patient needed long-term treatment aimed at controlling hypoglycaemia because of non-resectable metastases. Many tumour types have been associated with NICTH. The crucial event in the development of NICTH seems to be overexpression of the IGF-II gene by the tumour. NICTH is characterised by recurrent fasting hypoglycaemia and is associated with the secretion of incompletely processed precursors of IGF-II ('big'-IGF-II) by the tumour. This induces dramatic secondary changes in the circulating levels of insulin, GH, IGF-I and IGF-binding proteins, resulting in an insulin-like hypoglycaemic activity of 'big'-IGF-II.
de Groot
Jan Willem B
JW
Department of Internal Medicine, Isala Klinieken, Dr van Heesweg 2, 8025 AB Zwolle, The Netherlands. j.w.b.de.groot@isala.nl
Rikhof
Bart
B
van Doorn
Jaap
J
Bilo
Henk J G
HJ
Alleman
Maarten A
MA
Honkoop
Aafke H
AH
van der Graaf
Winette T A
WT
D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007335:Insulin-Like Growth Factor II / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000235:genetics / Q000628:therapy; D012333:RNA, Messenger / Q000235:genetics
D001786:Blood Glucose; D012333:RNA, Messenger; D007335:Insulin-Like Growth Factor II