Clinical features of insulin-like growth factor-II producing non-islet-cell tumor hypoglycemia

• Published in: Growth hormone & IGF research Vol. 16; no. 4; pp. 211 - 216
• Main Authors: Fukuda, Izumi, Hizuka, Naomi, Ishikawa, Yukiko, Yasumoto, Kumiko, Murakami, Yuko, Sata, Akira, Morita, Junko, Kurimoto, Makiko, Okubo, Yumiko, Takano, Kazue
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.08.2006
• Subjects: Adolescent; Adrenal Gland Neoplasms - secretion; Adult; Aged; Aged, 80 and over; Blood Glucose - analysis; Breast Neoplasms - secretion; Carcinoma, Hepatocellular - secretion; Carcinoma, Renal Cell - secretion; Child; Female; Fibrosarcoma - secretion; Gastrointestinal Stromal Tumors - secretion; Humans; Hypoglycemia; Hypoglycemia - etiology; Insulin-Like Growth Factor I - analysis; Insulin-Like Growth Factor II; Leiomyosarcoma - secretion; Liver Neoplasms - secretion; Male; Middle Aged; Neoplasms - pathology; Neoplasms - secretion; Pancreatic Neoplasms - secretion; Pheochromocytoma - secretion; Prostatic Neoplasms - secretion; Proteins - secretion; Retrospective Studies; Stomach Neoplasms - secretion; Tumor; Hypoglycemia; Tumor; Insulin-like growth factor-II
• ISSN: 1096-6374; 1532-2238
• DOI: 10.1016/j.ghir.2006.05.003

In some patients with non-islet-cell tumor hypoglycemia (NICTH), a high molecular weight form of IGF-II (big IGF-II) derived from tumors is present in the circulation and might be associated with recurrent hypoglycemia. In this study, in order to survey the clinical characteristics of patients with IGF-II producing NICTH, we analyzed the medical records of 78 patients with NICTH (M/F 44/34, age 62 ± 1.8, range; 9–86 years.) whose serum contained a large amount of big IGF-II. Hepatocellular carcinoma and gastric carcinoma were the most common causes of NICTH. The diameters of the tumors were more than 10 cm in 70% of the patients. Basal immunoreactive insulin (IRI) levels were less than 3 μU/dl in 79% of the patients. Hypoglycemic attack was the onset of disease in 31 of 65 cases (48%), but the tumor was revealed prior to the occurrence of hypoglycemia in 34 cases (52%). Twenty-five of 47 (53%) patients had decreased serum potassium levels. These data suggested that hypoinsulinemic hypoglycemia associated with the presence of a large tumor supports the diagnosis of IGF-II producing NICTH. Hypokalemia was associated with hypoglycemia in some patients. The BMI (21.4 ± 0.6 kg/m 2) and serum total protein levels (6.6 ± 0.1 g/dl) were preserved at the occurrence of first hypoglycemic attack suggesting that malnutrition might not be the main cause of hypoglycemia in most patients.