title: Estimation of glucose utilization in a type 2 diabetes mellitus patient on insulin analogs with tumor hypoglycemia induced by IGF-II.
abstract: We present a 38-year-old male patient with insulin requiring type 2 diabetes mellitus (DM) who had fasting hypoglycemia caused by a non-pancreatic-islet-cell mesenchymal tumor producing IGF-II. The evaluation was confounded in that there was pre-existing DM being treated with insulin analogs. Insulin levels were assessed with an immunoassay with cross reactivity with the insulin analogs. An 18-Fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) scan localized the 19.7×18.0×17.8cm retroperitoneal mass. A 3.25kg tumor was resected. Post-operatively insulin treatment was resumed and circulating IGF-II levels returned to normal. The maximum standardized uptake values of FDG (SUVmax) along with a steady state glucose infusion of 17.5g/h were used to determine the components of glucose utilization due to IGF-II induced muscle glucose uptake (utilization, 62%) whereas the tumor itself was responsible for approximately 22% of measurable glucose uptake. Whereas tumor induced hypoglycemia has been ascribed to preferential glucose utilization by the tumor, the predominant hypoglycemic effect was due to hormonal IGF-II induced total body glucose uptake.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States. Electronic address: sureshchode@gmail.com.
authors.forename: Suresh
authors.initials: S
authors.lastname: Chode
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States.
authors.forename: Stewart G
authors.initials: SG
authors.lastname: Albert
authors.affiliation: Department of Biochemistry, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States.
authors.forename: James D
authors.initials: JD
authors.lastname: Shoemaker
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States.
authors.forename: Aileen L
authors.initials: AL
authors.lastname: Green
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism*; D005947:Glucose / Q000493:pharmacokinetics*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives; D007335:Insulin-Like Growth Factor II / Q000009:adverse effects / Q000378:metabolism; D008297:Male; D012186:Retroperitoneal Neoplasms / Q000150:complications* / Q000378:metabolism
chemical_list: D007004:Hypoglycemic Agents; C035170:IGF2 protein, human; D007328:Insulin; D007335:Insulin-Like Growth Factor II; D005947:Glucose
keywords: 18-Fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) scan; Hypoglycemia; IGF-II; NICTH; Non-islet cell tumor hypoglycemia; Tumor induced hypoglycemia