Abstract
A 64 year old woman with a long history of "drop attacks" and dizzy spells was found to have spontaneous hypoglycaemia. A slowly enlarging pleural mass had been present for at least five years. At thoracotomy the mass (weight 1.7 kg) was excised and the hypoglycaemia ceased. Histologically the tumour was a pleural fibroma, with no features of malignancy. Endocrine tests before surgery showed a subnormal growth hormone response to spontaneous hypoglycaemia, a reduced concentration of serum insulin like growth factor I (IGF-I), and an inappropriately high concentration of serum insulin like growth factor II (IGF-II). After resection of the tumour the growth hormone response to insulin induced hypoglycaemia and the IGF-I and IGF-II concentrations were normal. These data suggest that the hypoglycaemia was due to production of IGF-II by the tumour, causing increased glucose utilisation and an impaired growth hormone counterregulatory response to hypoglycaemia.
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- Daughaday W. H. Hypoglycemia in patients with non-islet cell tumors. Endocrinol Metab Clin North Am. 1989 Mar;18(1):91–101. [PubMed] [Google Scholar]
- Gorden P., Hendricks C. M., Kahn C. R., Megyesi K., Roth J. Hypoglycemia associated with non-islet-cell tumor and insulin-like growth factors. N Engl J Med. 1981 Dec 10;305(24):1452–1455. doi: 10.1056/NEJM198112103052405. [DOI] [PubMed] [Google Scholar]
- Guler H. P., Zapf J., Froesch E. R. Short-term metabolic effects of recombinant human insulin-like growth factor I in healthy adults. N Engl J Med. 1987 Jul 16;317(3):137–140. doi: 10.1056/NEJM198707163170303. [DOI] [PubMed] [Google Scholar]
- Kahn C. R. The riddle of tumour hypoglycaemia revisited. Clin Endocrinol Metab. 1980 Jul;9(2):335–360. doi: 10.1016/s0300-595x(80)80037-5. [DOI] [PubMed] [Google Scholar]
- Lowe W. L., Jr, Roberts C. T., Jr, LeRoith D., Rojeski M. T., Merimee T. J., Fui S. T., Keen H., Arnold D., Mersey J., Gluzman S. Insulin-like growth factor-II in nonislet cell tumors associated with hypoglycemia: increased levels of messenger ribonucleic acid. J Clin Endocrinol Metab. 1989 Dec;69(6):1153–1159. doi: 10.1210/jcem-69-6-1153. [DOI] [PubMed] [Google Scholar]
- Ron D., Powers A. C., Pandian M. R., Godine J. E., Axelrod L. Increased insulin-like growth factor II production and consequent suppression of growth hormone secretion: a dual mechanism for tumor-induced hypoglycemia. J Clin Endocrinol Metab. 1989 Apr;68(4):701–706. doi: 10.1210/jcem-68-4-701. [DOI] [PubMed] [Google Scholar]
- Teale J. D., Marks V. Inappropriately elevated plasma insulin-like growth factor II in relation to suppressed insulin-like growth factor I in the diagnosis of non-islet cell tumour hypoglycaemia. Clin Endocrinol (Oxf) 1990 Jul;33(1):87–98. doi: 10.1111/j.1365-2265.1990.tb00469.x. [DOI] [PubMed] [Google Scholar]