Recurrent Non-islet Cell Tumor Hypoglycemia Secondary to Hepatocellular Carcinoma: Case Report and Literature Review

Abstract

Rationale Non-islet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome caused by tumors other than insulinoma that is primarily due to excessive production of insulin-like growth factor-II (IGF-II). The prevalence of NICTH is likely underestimated because of a lack of clinical recognition.

Patient Concerns A 41-year-old male with massive malignant liver tumors presented with recurrent severe hypoglycemia, weight loss, and liver cirrhosis.

Diagnosis NICTH related to IGF-II produced by hepatocellular carcinoma was diagnosed based on clinical symptoms, biochemical tests, and elevated IGF-II/IGF-I ratio.

Intervention Initial treatment with intravenous glucose and parenteral nutrition showed limited efficacy. Glucocorticoids and recombinant human growth hormone led to progressive improvement in blood glucose levels.

Outcome Due to extensive tumor burden and liver failure, surgical resection was not feasible, and the patient ultimately succumbed to refractory hypoglycemia and passed away in two weeks.

Lessons Early recognition and diagnosis of NICTH are crucial in patients with recurrent hypoglycemia and large tumors. Surgical resection is the preferred treatment option, but supportive care and pharmacological interventions, such as glucocorticoids and growth hormone, can help manage refractory hypoglycemia. Further research is needed to explore novel treatment options, including anti-IGF-I and -IGF-II neutralizing antibodies.

Zusammenfassung

Hintergrund Nicht-Inselzelltumor-Hypoglykämie (NICTH) ist ein paraneoplastisches Syndrom, das durch andere Tumoren als Insulinome verursacht wird. NICTH ist hauptsächlich auf eine übermäßige Produktion von insulinähnlichem Wachstumsfaktor II (IGF-II) zurückzuführen. Die Prävalenz von NICTH wird aufgrund mangelnder klinischer Anerkennung wahrscheinlich unterschätzt.

Anliegen des Patienten Ein 41-jähriger Mann mit massiven bösartigen Lebertumoren stellte sich mit rezidivierender schwerer Hypoglykämie, Gewichtsverlust und Leberzirrhose vor.

Diagnose NICTH im Zusammenhang mit IGF-II, das durch ein hepatozelluläres Karzinom hervorgerufen wird, wurde anhand klinischer Symptome, biochemischer Tests und eines erhöhten IGF-II/IGF-I-Verhältnisses diagnostiziert.

Medizinischer Eingriff Die anfängliche Behandlung mit intravenöser Glukose und parenteraler Ernährung zeigte eine begrenzte Wirksamkeit. Glukokortikoide und rekombinantes menschliches Wachstumshormon führten zu einer fortschreitenden Verbesserung des Blutzuckerspiegels

Ergebnisse Eine chirurgische Resektion war aufgrund der hohen Tumorlast und des Leberversagens nicht durchführbar. Der Patient erlag schließlich einer refraktären Hypoglykämie und verstarb innerhalb von zwei Wochen.

Blick nach vorne Die frühzeitige Erkennung und Diagnose von NICTH ist bei Patienten mit wiederkehrender Hypoglykämie und großen Tumoren von entscheidender Bedeutung. Die chirurgische Resektion ist die bevorzugte Behandlungsoption, aber unterstützende Maßnahmen und pharmakologische Interventionen wie Glukokortikoide und Wachstumshormone können bei der Behandlung einer refraktären Hypoglykämie helfen. Weitere Forschung ist erforderlich, um neue Behandlungsmöglichkeiten zu erkunden, einschließlich neutralisierender Anti-IGF-I- und IGF-II-Antikörper.

Keywords

case report - hepatocellular carcinoma - non-islet-cell tumor hypoglycemia - insulin-like growth factor - liver - metastasis

Schlüsselwörter

Fallbericht - hepatozelluläres Karzinom - Hypoglykämie von Nicht-Inselzelltumoren - insulinähnlicher Wachstumsfaktor - Leber - Metastasierung

Publication History

Received: 05 July 2023

Article published online:
05 October 2023

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