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Letter to the Editor
IGF-2-mediated resistant hypoglycemia in a patient with a nonislet cell tumor
Hipoglucemia resistente mediada por IGF-2 en un paciente con un tumor de células no beta
Ignacio Ruiz García
Corresponding author
, Francisco José Sánchez Torralvo, Victoria Contreras Bolívar
Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, Málaga, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The etiological diagnosis of recurrent hypoglycaemia represents a real challenge for the clinician&#46; There are a multitude of causes that can lead to hypoglycaemia&#58; hypoglycaemic drugs&#44; malnutrition&#44; sepsis&#44; liver disease&#44; etc&#46; Neoplasm-associated hypoglycaemia is a separate entity&#44; which may also be caused by different mechanisms&#58; production of insulin&#44; IL-1&#44; IL-6&#44; destruction of the liver or adrenal glands&#44; etc&#46; In all cases&#44; the patient must be assessed in a comprehensive way and any potential causes of hypoglycaemia must be considered&#44; without overlooking those that are uncommon&#46; The aim of this paper is precisely to take into consideration one of these low-frequency causes that should be considered in the differential diagnosis&#58; overproduction of IGF-2&#44; known as Doege&#8211;Potter syndrome&#46; The estimated incidence is 1 case per million population&#44; with very few cases reported worldwide&#46; This paper describes the case of a patient treated in our department&#46; It includes how to reach the diagnosis and the effective treatment available&#44; according to the latest available evidence&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an 83-year-old male patient with a history of chronic obstructive pulmonary disease and diagnosis of a solitary fibrous tumour of the pleura 3&#160;years earlier&#46; The patient refused surgical intervention for the tumor&#44; so he continued follow-up by the Pneumology Department&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">His family doctor detected fasting glucose levels &#60;70&#160;mg&#47;dl in the control tests&#44; which had not caused any symptoms&#46; However&#44; sometime later&#44; the patient began to present with numerous episodes of hypoglycaemia together with neuroglycopenic symptoms that required emergency care&#46; Given the frequency and poor response to hygienic-dietary measures&#44; the patient was admitted for further evaluation&#46; Hypoglycaemia&#44; with fasting glucose levels below 50&#160;mg&#47;dl&#44; was confirmed with blood tests&#46; Coinciding with these&#44; the patient showed symptoms of hypoglycaemia that disappeared with glucose intake&#44; thus fulfilling Whipple&#39;s triad&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The laboratory tests on admission showed normal renal and hepatic function values&#46; The patient&#39;s ingesta was normal&#46; On admission&#44; he received glucose solution and a diet rich in complex carbohydrates administered abundantly and frequently&#46; Even with these measures&#44; he continued to require frequent use of 50&#37; glucose solution as rescue to correct episodes of hypoglycaemia&#46; A blood test was performed in one of the hypoglycaemia episodes and the following results were obtained&#58; C-peptide &#60;0&#46;2&#160;ng&#47;ml and insulin &#60;3&#160;&#181;U&#47;ml&#44; with no oral antidiabetic agents being detected&#46; These data&#44; considering the patient&#39;s history&#44; focused on hypoglycaemia due to non-islet cell tumour &#40;NICT&#41; as the most likely aetiology&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After the etiological work-up&#44; empirical treatment with prednisone 20&#160;mg&#47;12&#160;h was initiated and glucose solution was discontinued&#46; With these measures&#44; blood glucose remained in the normal range&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The following results were then obtained from a reference laboratory&#58; IGF-1&#58; 36&#160;ng&#47;ml &#40;normal 55&#8722;166&#160;ng&#47;ml&#41;&#44; IGF-2&#58; 481&#160;ng&#47;ml &#40;normal 350&#8722;481&#160;ng&#47;dl&#41;&#44; IGF 2&#47;IGF 1 ratio&#58; 13&#46;36 &#40;normal &#60; 10&#41;&#46; These results confirmed that the origin of the recurrent hypoglycaemias was IGF-2 synthesis by the fibrous tumour of the pleura&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Given the characteristics of the patient and the size of the tumour&#44; the Thoracic Tumour Committee decided to continue with conservative measures&#46; Prednisone treatment was maintained&#44; and the patient did not experience any further episodes of hypoglycaemia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">There are many NICTs capable of causing hypoglycaemia&#46; They are generally large in size and are normally found in the thoracic or retroperitoneal region&#46; If the hypoglycaemia is caused by a fibrous tumour found in the chest&#44; it is called Doege&#8211;Potter syndrome&#46; The solitary fibrous pleural tumour is the most common hypoglycaemia-producing NICT&#46; The most common cause of hypoglycaemia due to NICT is tumour overproduction of an insulin-like factor&#44; usually incompletely processed IGF-2&#44; called pro-IGF-2&#44; or more rarely&#44; IGF-1&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> IGF-2-producing NICTs develop this molecule with a higher molecular weight than usual&#46; Although many cases of NICT have elevated IGF2 levels&#44; cases with normal or low values have also been reported&#46; This discrepancy is thought to be due to variability in laboratory measurement methods and their ability to detect abnormal forms of IGF-2&#46; IGFs induce an increase in glucose utilisation and an inhibition of glucose release from the liver and ketogenesis&#46; Pro-IGF-2 also suppresses the counter-regulatory hormones glucagon and GH&#46; Approximately half of the cases of NICT present with hypoglycaemia as the first manifestation of the tumour&#46; The other half have the tumour identified prior to the onset of hypoglycaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of NICT hypoglycaemia is based on clinical and biochemical findings&#46; When a patient with a known tumour presents with hypoglycaemia&#44; the cause is usually evident from the clinical history and examination&#46; When the cause is not obvious&#44; laboratory tests are needed&#46; Initial laboratory evaluation includes measurement of glucose&#44; insulin&#44; proinsulin&#44; C-peptide&#44; beta-hydroxybutyrate&#44; and sulfonylureas&#47;meglitinides during a hypoglycaemic episode&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> A low hydroxybutyrate level points to insulin or IGF hypoglycaemia&#46; Insulin&#44; C-peptide&#44; and proinsulin levels are elevated in subjects with insulinomas&#44; oral hypoglycaemic agents&#44; and insulin autoimmunity&#46; Sulfonylureas or meglitinides are present in hypoglycaemia mediated by these oral hypoglycaemic agents&#46; In patients with exogenous insulin administration&#44; plasma insulin levels are higher than in insulinoma&#44; but C-peptide and proinsulin have low values&#46; In contrast to individuals with hyperinsulinemic hypoglycaemia&#44; patients with IGF hypoglycaemia have low levels of insulin and C-peptide during hypoglycaemia&#46; When an IGF-producing NICT is suspected&#44; GH&#44; IGF-1&#44; and IGF-2 are measured&#46; GH levels are typically low &#40;except in brief episodes of hypoglycaemia in which its production is stimulated&#41;&#46; Depending on the IGF-2 measurement method&#44; the levels may or may not be elevated&#44; as discussed above&#46; Although the levels are normal&#44; IGF-1 will be suppressed below 100&#160;ng&#47;ml&#44; so the IGF-2&#47;IGF-1 ratio is high&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The finding of hypoglycaemia with low levels of insulin&#44; C-peptide&#44; and beta-hydroxybutyrate in an apparently healthy person should lead to a rapid tumour search by cross-sectional imaging of the chest&#44; abdomen&#44; and pelvis&#44; because in most cases these tumours are located there&#46; Dynamic tests can be performed in patients with suspected adrenal failure&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Logically&#44; the main treatment to resolve hypoglycaemia is that of the tumour itself&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;5</span></a> When a tumour is producing IGF&#44; complete removal of the tumour cures hypoglycaemia&#46; If the tumour is not resectable&#44; a reduction of the tumour mass is usually performed&#46; In addition&#44; depending on the type of tumour&#44; chemotherapy&#44; radiotherapy&#44; or selective embolization of the blood vessels that nourish the tumour may be used&#46; If the tumour cannot be treated&#44; glucocorticoids are initiated at equivalent doses of prednisone 30&#8722;60&#160;mg&#47;dl&#46; These decrease the amount of macro IGF-2 by suppressing its production or increasing its clearance&#46; In addition&#44; they stimulate gluconeogenesis and decrease IGF-2 outflow from the endothelial barrier&#46; If hypoglycaemia persists&#44; continuous intravenous infusion of glucagon &#40;0&#46;06&#8722;0&#46;3&#160;mg&#47;h&#41; can be used&#59; recombinant GH could also be used at supraphysiological doses of 3&#8722;12&#160;mg&#47;day&#46; GH suppresses peripheral glucose uptake and decreases passage through the endothelial barrier of IGF-2&#44; but its use may be limited by the need for high doses with side effects&#46; Diazoxide and octreotide decrease the secretion of insulin by the pancreatic islet cells&#44; so they are not useful in NICT&#44; as hypoglycaemia is not due to hyperproduction of insulin by these cells&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion&#44; in the care of patients with hypoglycaemia and neoplasms&#44; a targeted history-taking and examination are particularly relevant&#44; as well as a correct interpretation of laboratory findings&#44; considering the possibility of less common aetiologies in the differential diagnosis&#44; such as IGF-2 overproduction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest for this publication&#46;</p></span></span>"
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                            4 => "Y&#46; Zhao"
                            5 => "J&#46; He"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "link" => array:1 [
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                0 => array:2 [
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                    0 => array:2 [
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                            3 => "Z&#46; Tudos"
                            4 => "D&#46; Karasek"
                            5 => "M&#46; Iacobone"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.7150/jca.30472"
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                        "tituloSerie" => "J Cancer"
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                        "volumen" => "10"
                        "paginaInicial" => "6475"
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                        "link" => array:1 [
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos