title: Severe hypoglycemia associated with insulin-like growth factor II-producing liver metastasis from gastric carcinoma treated with overnight total parenteral nutrition via a central vein catheter reserve port.
abstract: Hypoglycemia caused by insulin-like growth factor II is difficult to control. A 77-year-old woman was diagnosed with gastric cancer and multiple liver metastases in September 2006 and underwent chemotherapy; however, at that time there were no symptoms of hypoglycemia. From January 2007 onwards, hypoglycemic comas and symptoms of hypoglycemia began to appear frequently. Her serum level of insulin was normal; thus, we suspected the presence of big insulin-like growth factor II was causing the hypoglycemia. This was proven by Western immunoblotting and we diagnosed non-islet cell tumor hypoglycemia associated with gastric cancer. Overnight nutrition provided via a central venous catheter port to prevent hypoglycemia allowed the patient to become ambulant and to remain free of hypoglycemic coma at follow-up until her death 7 months later.
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Koizumi
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Nayu
authors.initials: N
authors.lastname: Tazuya
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Misa
authors.initials: M
authors.lastname: Ichiryu
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Nakahara
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ochi
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanabe
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hidaka
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kodama
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Uehara
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Hasebe
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Yasunao
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, 790-0024, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Horiike
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan. hiasa@m.ehime-u.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
authors.forename: Morikazu
authors.initials: M
authors.lastname: Onji
keywords: Gastric carcinoma; Hypoglycemia; Insulin-like growth factor (IGF)-II; Non-islet cell tumor hypoglycemia (NICTH)