Fatal hypoglycemia in malignant pheochromocytoma: direct glucose consumption as suggested by (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging.
We present a patient with metastatic pheochromocytoma, who developed progressive and fatal hypoglycemia most likely secondary to direct tumor glucose consumption that did not respond to high-dose glucose infusion, corticosteroids, or glucagon therapy. The pattern of glucose uptake on (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography, with preferential tumor glucose uptake in association with a marked reduction in normal uptake in the heart, muscles, and brain, is highly suggestive of direct consumption of glucose by the tumor rather than insulin-like growth factor-2 mediated hypoglycemia. In patients with large-volume metastatic malignancies, direct tumor glucose consumption should be considered in the differential diagnosis of hypoglycemia. Nuclear medicine imaging techniques can illustrate the pathophysiology of hypoglycemia in such cases.
Habra
Mouhammed Amir
MA
Department of Endocrine Neoplasia and Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Núñez
Rodolfo
R
Chuang
Hubert
H
Ayala-Ramirez
Montserrat
M
Rich
Thereasa
T
Kyle
Karen
K
Jimenez
Camilo
C
D000310:Adrenal Gland Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D001859:Bone Neoplasms / Q000556:secondary; D018450:Disease Progression; D017809:Fatal Outcome; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D010673:Pheochromocytoma / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon; D047368:Tumor Burden; D055815:Young Adult
D019788:Fluorodeoxyglucose F18; D005947:Glucose