title: Insulin-like growth factor II-producing metastatic colon cancer with recurrent hypoglycemia.
abstract: A 45-year-old man was referred to our hospital and found to have a tubular adenocarcinoma of the descending colon with multiple liver metastases. During hospitalization, the patient suffered recurrent hypoglycemic attacks that required intravenous 50% glucose infusion. He was diagnosed with non-islet cell tumor hypoglycemia (NICTH) because the colon cancer tissue obtained by biopsy was strongly stained for insulin-like growth factor-II (IGF-II) by immunohistochemistry. He received chemotherapy with oxaliplatin, 5-FU and leucovorin (FOLFOX) plus bevacizumab (Bmab), and showed a partial response. As the metastatic lesions decreased in size, the hypoglycemic attacks gradually disappeared. Subsequently, he received outpatient chemotherapy and maintained a high quality of life for about 10 months. Western blot analysis of IGF-II in serum at the time of admission showed a high-molecular-weight form of IGF-II, which was considered to have caused hypoglycemia. This patient presents a very rare case of colorectal cancer associated with NICTH syndrome due to production of high-molecular-weight IGF-II by cancer cells. It is important to investigate IGF-II expression in cancer tissues for establishing the diagnosis of NICTH in cases with intractable hypoglycemia complicated by advanced cancer.
authors.affiliation: Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramae
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Muguruma
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Okada
authors.forename: Takahiro
authors.initials: T
authors.lastname: Goji
authors.forename: Shinji
authors.initials: S
authors.lastname: Kitamura
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kimura
authors.forename: Masako
authors.initials: M
authors.lastname: Kimura
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Bando
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Takayama
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry / Q000150:complications* / Q000473:pathology*; D015153:Blotting, Western; D003110:Colonic Neoplasms / Q000737:chemistry / Q000150:complications* / Q000473:pathology*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007150:Immunohistochemistry; D007335:Insulin-Like Growth Factor II / Q000032:analysis*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D012008:Recurrence
chemical_list: D007335:Insulin-Like Growth Factor II