title: Ovarian tumors secreting insulin.
abstract: Combined ovarian germ cell and neuroendocrine tumors are rare. Only few cases of hyperinsulinism due to ovarian ectopic secretion have been hypothesized in the literature. An ovarian tumor was diagnosed in a 76-year-old woman, referred to our department for recurrent hypoglycemia with hyperinsulinism. In vivo tests, in particular fasting test, rapid calcium infusion test, and Octreotide test were performed. Ectopic hyperinsulinemic hypoglycemia was demonstrated in vivo and hypoglycemia disappeared after hysteroadnexectomy. Histological exam revealed an ovarian germ cell tumor with neuroendocrine and Yolk sac differentiation, while immunostaining showed insulin positivity in neuroendocrine cells. A cell culture was obtained by tumoral cells, testing Everolimus, and Pasireotide. Insulin was detected in cell culture medium and Everolimus and Pasireotide demonstrated their potentiality in reducing insulin secretion, more than controlling cell viability. Nine cases of hyperinsulinism due to ovarian ectopic secretion reported in literature have been reviewed. These data confirm the ovarian tissue potentiality to induce hyperinsulinemic hypoglycemic syndrome after neoplastic transformation.
authors.affiliation: Internal Medicine 3, Department of Medicine, University of Padua, Via Giustiniani 2, 35100, Padua, Italy, marialberta@hotmail.it.
authors.forename: Marialberta
authors.initials: M
authors.lastname: Battocchio
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Zatelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Chiarelli
authors.forename: Mariangela
authors.initials: M
authors.lastname: Trento
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Ambrosio
authors.forename: Claudio
authors.initials: C
authors.lastname: Pasquali
authors.forename: Eugenio
authors.initials: E
authors.lastname: De Carlo
authors.forename: Francesca
authors.initials: F
authors.lastname: Dassie
authors.forename: Roberto
authors.initials: R
authors.lastname: Mioni
authors.forename: Andrea
authors.initials: A
authors.lastname: Rebellato
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallo
authors.forename: Ettore
authors.initials: E
authors.lastname: Degli Uberti
authors.forename: Chiara
authors.initials: C
authors.lastname: Martini
authors.forename: Roberto
authors.initials: R
authors.lastname: Vettor
authors.forename: Pietro
authors.initials: P
authors.lastname: Maffei
mesh_terms: D000368:Aged; D002118:Calcium / Q000378:metabolism; D002478:Cells, Cultured; D018240:Endodermal Sinus Tumor / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000068338:Everolimus / Q000494:pharmacology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000378:metabolism*; D007340:Insulinoma / Q000378:metabolism*; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D015282:Octreotide / Q000378:metabolism; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D013004:Somatostatin / Q000031:analogs & derivatives / Q000494:pharmacology
chemical_list: D007328:Insulin; D013004:Somatostatin; C517782:pasireotide; D000068338:Everolimus; D015282:Octreotide; D002118:Calcium