Tumor and non-tumor mediated hypoglycemia by pancreatic beta cells, a diagnostic challenge
Hipoglucemia tumoral dependiente y no dependiente de células β-pancreáticas, un reto diagnóstico
Article Sidebar
PDF (Español (España))
FLIP
HTML (Español (España))
EPUB (Español (España))
Main Article Content
Abstract
Hypoglycemia is a common medical emergency which is mostly secondary to the use of oral or injected hypoglycemic drugs indicated in patients with diabetes mellitus. However, it can present spontaneously and severely in relation to multiple clinical conditions, including neoplasms. When faced with hypoglycemia associated with paraneoplastic disorders, the pathophysiological mechanisms of hypoglycemia must be recognized and a timely and accurate diagnosis must be established in order to diminish complications inherent to this clinical syndrome. We herein present two patients with hypoglycemia refractory to initial medical management, sharing similar appearance with other pathologies. The first case corresponds to a patient with an insulinoma and the second to a patient with a hemangiopericytoma.
Downloads
Article Details
References
Edridge CL, Dunkley AJ, Bodicoat DH, Rose TC, Gray LJ, Davies MJ, et al. Prevalence and Incidence of Hypoglycaemia in 532,542 People with Type 2 Diabetes on Oral Therapies and Insulin: A Systematic Review and Meta-Analysis of Population Based Studies. PLoS One. 2015;10(6):e0126427. doi: 10.1371/journal.pone.0126427 DOI: https://doi.org/10.1371/journal.pone.0126427
Kandaswamy L, Raghavan R, Pappachan JM. Spontaneous hypoglycemia: diagnostic evaluation and management. Endocrine. 2016;53(1):47-57. doi: 10.1007/s12020-016-0902-0. DOI: https://doi.org/10.1007/s12020-016-0902-0
Takeishi S, Mori A, Hachiya H, Yumura T, Ito S, Shibuya T, et al. Hypoglycemia and glycemic variability are associated with mortality in non-intensive care unit hospitalized infectious disease patients with diabetes mellitus. J Diabetes Investig. 2016;7(3):429-35. doi: 10.1111/jdi.12436 DOI: https://doi.org/10.1111/jdi.12436
Martens P, Tits J. Approach to the patient with spontaneous hypoglycemia. Eur J Intern Med. 2014;25(5):415-21. doi: 10.1016/j.ejim.2014.02.011 DOI: https://doi.org/10.1016/j.ejim.2014.02.011
Palmer SC, Mavridis D, Nicolucci A, Johnson DW, Tonelli M, Craig JC, et al. Comparison of Clinical Outcomes and Adverse Events Associated With Glucose-Lowering Drugs in Patients With Type 2 Diabetes: A Meta-analysis. JAMA. 2016;316(3):313-24. doi: 10.1001/jama.2016.9400 DOI: https://doi.org/10.1001/jama.2016.9400
Iglesias P, Díez JJ. Management of endocrine disease: a clinical update on tumor-induced hypoglycemia. Eur J Endocrinol. 2014;170(4):R147-57. doi: 10.1530/EJE-13-1012 DOI: https://doi.org/10.1530/EJE-13-1012
Service FJ, McMahon MM, O'Brien PC, Ballard DJ. Functioning insulinoma--incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc. 1991;66(7):711-9. doi: 10.1016/s0025-6196(12)62083-7 DOI: https://doi.org/10.1016/S0025-6196(12)62083-7
Vaidakis D, Karoubalis J, Pappa T, Piaditis G, Zografos GN. Pancreatic insulinoma: current issues and trends. Hepatobiliary Pancreat Dis Int. 2010;9(3):234-41.
Halfdanarson TR, Rubin J, Farnell MB, Grant CS, Petersen GM. Pancreatic endocrine neoplasms: epidemiology and prognosis of pancreatic endocrine tumors. Endocr Relat Cancer. 2008;15(2):409-27. doi: 10.1677/ERC-07-0221 DOI: https://doi.org/10.1677/ERC-07-0221
Mathur A, Gorden P, Libutti SK. Insulinoma. Surg Clin North Am. 2009;89(5):1105-21. doi: 10.1016/j.suc.2009.06.009 DOI: https://doi.org/10.1016/j.suc.2009.06.009
Garcia-Molina FJ, Franco Osorio JD, Medina Diez J. Retroperitoneal pelvic hemangiopericytoma. Combined abdominoperineal resection. Rev Esp Enferm Dig. 2002;94(9):558-63.
Essola B, Remmelink M, Kessler R, Scillia P, Rocmans P. [Primary pulmonary hemangiopericytoma: 2 new cases]. Rev Med Brux. 2003;24(5):408-15.
Rosenblatt GS, Walsh CJ, Basile JJ. Pelvic hemangiopericytoma in a patient with mixed germ cell tumor of the testis. J Urol; 166(5):1824-5. DOI: https://doi.org/10.1016/S0022-5347(05)65685-6
Khowaja A, Johnson-Rabbett B, Bantle J, Moheet A. Hypoglycemia mediated by paraneoplastic production of Insulin like growth factor-2 from a malignant renal solitary fibrous tumor - clinical case and literature review. BMC Endocr Disord. 2014;14:49. doi: 10.1186/1472-6823-14-49 DOI: https://doi.org/10.1186/1472-6823-14-49
Livingstone C. IGF2 and cancer. Endocr Relat Cancer. 2013;20(6):R321-39. doi: 10.1530/ERC-13-0231. DOI: https://doi.org/10.1530/ERC-13-0231
Fama F, Le Bouc Y, Barrande G, Villeneuve A, Berry MG, Pidoto RR, et al. Solitary fibrous tumour of the liver with IGF-II-related hypoglycaemia. A case report. Langenbecks Arch Surg. 2008;393(4):611-6.
Rikhof B, van Doorn J, Suurmeijer AJ, Rautenberg MW, Groenen PJ, Verdijk MA, et al. Insulin-like growth factors and insulin-like growth factor-binding proteins in relation to disease status and incidence of hypoglycaemia in patients with a gastrointestinal stromal tumour. Ann Oncol. 2009;20(9):1582-1588. doi: 10.1093/annonc/mdp038 DOI: https://doi.org/10.1093/annonc/mdp038
Rosenbaum JN, Lloyd RV. Pancreatic Neuroendocrine Neoplasms. Surg Pathol Clin. 2014;7(4):559-75. doi: 10.1016/j.path.2014.08.005 DOI: https://doi.org/10.1016/j.path.2014.08.005