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Causes and Evaluation of Tumor-Induced Hypoglycemia

Causes and Evaluation of Tumor-Induced Hypoglycemia Abstract • We treated four patients who had hypoglycemia and non-pancreatic tumors. Two had pleural mesothelioma, one had primary fibrosarcoma of the liver, and one had pheochromocytoma metastatic to the liver. We propose four mechanisms for this syndrome: (1) insulin or insulin-like activity produced by the tumor, (2) decreased gluconeogenesis, (3) disruption of glucagon metabolism, and (4) increased utilization of glucose by the tumor. The local effects of the tumor in hepatic parenchyma may also play an important role. The important diagnostic tests are an insulin-glucose ratio, to rule out insulinoma, and fasting glucose levels. An assay of nonsuppressible insulin-like activity can be performed and is of investigative interest, but does not aid in individual patient therapy. Treatment consists of control of the tumor. (Arch Surg 1982;117:905-908. References 1. Oleesky S, Bailey I, Samols E, et al: A fibrosarcoma with hypoglycemia and a high serum insulin level . Lancet 1962;2:378-379.Crossref 2. August JT, Hiatt HH: Severe hypoglycemia secondary to a non-pancreatic fibrosarcoma with insulin activity . N Engl J Med 1958;258:17.Crossref 3. Lyall SS, Marieb NJ, Wise JK, et al: Hyperinsulinemic hypoglycemia associated with a neurofibrosarcoma . Arch Intern Med 1975;125:865-867.Crossref 4. Megyesi K, Kahn CR, Roth J, et al: Hypoglycemia in association with extrapancreatic tumors: Demonstration of elevated plasma NSILA-S by a new radioreceptor assay . J Clin Endocrinol Metab 1974;38:931.Crossref 5. Diasio RB, Eanes RZ, Chen MLW, et al: Adenocarcinoma of the pancreas associated with hypoglycemia: Case report and review of the literature . Cancer 1979;43:2457-2464.Crossref 6. Chase LR, Williamson JR: Metastatic carcinoma of the prostate and hypoglycemia: Clinicopathologic conference . Am J Med 1977;63:979-990.Crossref 7. Silbert CK, Rossini AA, Ghazvinian S, et al: Tumor hypoglycemia: Deficient splanchnic glucose output and deficient glucagon secretion . Diabetes 1975;25:202-206.Crossref 8. Kreisberg RA, Pennington LF: Tumor hypoglycemia: A heterogeneous disorder . Metabolism 1970;19:445-452.Crossref 9. Chandalia HB, Boshell BR: Hypoglycemia associated with extrapancreatic tumors: Report of two cases with studies on its pathogenesis . Arch Intern Med 1972;129:447-456.Crossref 10. McDaniel GH, Boshell BR, Reddy WJ: Hypoglycemic action of tryptophans . Diabetes 1973;22:713-718. 11. Silverstein MN, Wakim KG, Bahn RC: Tryptophan metabolites in hypoglycemia associated with neoplasia . Cancer 1966;19:2024-2028.Crossref 12. Lindkaer S, Kuhl C, Lauritsen KB, et al: Mesenchymal tumor hypoglycemia: The effect of a tumor tissue extract on the insulin and glucagon secretion from the isolated perfused porcine pancreas . Am J Surg 1978;135:192-195.Crossref 13. Chowdhury F, Bleicher SJ: Studies of tumor hypoglycemia . Metabolism 1973;22:663-674.Crossref 14. Landau BR, Wills N, Craig JW, et al: The mechanism of hepatoma induced hypoglycemia . Cancer 1962;15:1188-1196.Crossref 15. Mann FC: Effect of complete and partial removal of the liver . Medicine 1927;6:419.Crossref 16. Mellinkoff SM, Tumulty PA: Hepatic hypoglycemia: Its occurrence in congestive heart failure . N Engl J Med 1952;247:745-750.Crossref 17. McFadzean AJS, Young TT: Hypoglycemia in primary carcinoma of the liver . Arch Intern Med 1956;98:720.Crossref 18. Papaioannou AN: Tumors other than insulinomas associated with hypoglycemia . Surg Gynecol Obstet 1966;123:1093-1099. 19. Nelson R, Burman SO, Kiani R, et al: Hypoglycemic coma associated with benign pleural mesothelioma . J Thorac Cardiovas Surg 1975;69:306-314. 20. Castro A, Florez L, Rozanski JJ, et al: Tumor associated hypoglycemia and elevated serum non-suppressible insulin-like activity . J Fla Med Assoc 1978;65:421-424. 21. Tsibris JCM, Raynor LO, Buhi CW, et al: Insulin receptors in circulating erythrocytes and monocytes from women on oral contraceptives or pregnant women near term . J Clin Endocrinol Metab 1980;51:711-717.Crossref 22. Puavilai G, MacCart JG, Domont LA, et al: Insulin resistance in human pregnancy: A post-receptor defect , abstracted. Clin Res 1979; 27:659. 23. Beck-Nielsen H, Kuhl C, Pederson O, et al: Decreased insulin binding to monocytes from normal pregnant women . J Clin Endocrinol Metab 1979;49:810-814.Crossref 24. Megyesi K, Kahn CR, Roth J, et al: Circulating NSILA-S in man: Preliminary studies of stimuli in vivo and of binding to plasma components . J Clin Endocrinol Metab 1975;41:475-484.Crossref 25. Bousvaros GA: Hypoglycemia in metastatic fibrosarcoma of the liver . Br Med J 1960;1:836-838.Crossref 26. Allen CTB, Imrie D: Hypoglycemia as a complication of removal of a pheochromocytoma . Can Med Assoc J 1977;116:363-364. 27. Wilkins GG, Schmidt N, Doll WA: Hypoglycemia following excision of pheochromocytoma . Can Med Assoc J 1977;116:367-368. 28. Khandekar, JD: Islet cell tumors of the pancreas: Clinico-biochemical correlations . Ann Clin Lab Sci 1979;9:212-215. 29. Dillon RS: Handbook of Endocrinology , ed 2. Philadelphia, Lea & Febiger, 1980, pp 201-202. 30. Stewart BH, Bravo EL, Haaga J, et al: Localization of pheochromocytoma by computed tomography . N Engl J Med 1978;299:460.Crossref 31. Frerichs H, Creutzfeldt W: Hypoglycemia: Insulin secreting tumors . J Clin Endocrinol Metab 1976;5:747-767.Crossref 32. Younus S, Soterakis J, Sossi AJ, et al: Hypoglycemia secondary to metastases to the liver: A case report and review of the literature . Gastroenterology 1977;72:334-337. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Causes and Evaluation of Tumor-Induced Hypoglycemia

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1982.01380310025006
Publisher site
See Article on Publisher Site

Abstract

Abstract • We treated four patients who had hypoglycemia and non-pancreatic tumors. Two had pleural mesothelioma, one had primary fibrosarcoma of the liver, and one had pheochromocytoma metastatic to the liver. We propose four mechanisms for this syndrome: (1) insulin or insulin-like activity produced by the tumor, (2) decreased gluconeogenesis, (3) disruption of glucagon metabolism, and (4) increased utilization of glucose by the tumor. The local effects of the tumor in hepatic parenchyma may also play an important role. The important diagnostic tests are an insulin-glucose ratio, to rule out insulinoma, and fasting glucose levels. An assay of nonsuppressible insulin-like activity can be performed and is of investigative interest, but does not aid in individual patient therapy. Treatment consists of control of the tumor. (Arch Surg 1982;117:905-908. References 1. Oleesky S, Bailey I, Samols E, et al: A fibrosarcoma with hypoglycemia and a high serum insulin level . Lancet 1962;2:378-379.Crossref 2. August JT, Hiatt HH: Severe hypoglycemia secondary to a non-pancreatic fibrosarcoma with insulin activity . N Engl J Med 1958;258:17.Crossref 3. Lyall SS, Marieb NJ, Wise JK, et al: Hyperinsulinemic hypoglycemia associated with a neurofibrosarcoma . Arch Intern Med 1975;125:865-867.Crossref 4. Megyesi K, Kahn CR, Roth J, et al: Hypoglycemia in association with extrapancreatic tumors: Demonstration of elevated plasma NSILA-S by a new radioreceptor assay . J Clin Endocrinol Metab 1974;38:931.Crossref 5. Diasio RB, Eanes RZ, Chen MLW, et al: Adenocarcinoma of the pancreas associated with hypoglycemia: Case report and review of the literature . Cancer 1979;43:2457-2464.Crossref 6. Chase LR, Williamson JR: Metastatic carcinoma of the prostate and hypoglycemia: Clinicopathologic conference . Am J Med 1977;63:979-990.Crossref 7. Silbert CK, Rossini AA, Ghazvinian S, et al: Tumor hypoglycemia: Deficient splanchnic glucose output and deficient glucagon secretion . Diabetes 1975;25:202-206.Crossref 8. Kreisberg RA, Pennington LF: Tumor hypoglycemia: A heterogeneous disorder . Metabolism 1970;19:445-452.Crossref 9. Chandalia HB, Boshell BR: Hypoglycemia associated with extrapancreatic tumors: Report of two cases with studies on its pathogenesis . Arch Intern Med 1972;129:447-456.Crossref 10. McDaniel GH, Boshell BR, Reddy WJ: Hypoglycemic action of tryptophans . Diabetes 1973;22:713-718. 11. Silverstein MN, Wakim KG, Bahn RC: Tryptophan metabolites in hypoglycemia associated with neoplasia . Cancer 1966;19:2024-2028.Crossref 12. Lindkaer S, Kuhl C, Lauritsen KB, et al: Mesenchymal tumor hypoglycemia: The effect of a tumor tissue extract on the insulin and glucagon secretion from the isolated perfused porcine pancreas . Am J Surg 1978;135:192-195.Crossref 13. Chowdhury F, Bleicher SJ: Studies of tumor hypoglycemia . Metabolism 1973;22:663-674.Crossref 14. Landau BR, Wills N, Craig JW, et al: The mechanism of hepatoma induced hypoglycemia . Cancer 1962;15:1188-1196.Crossref 15. Mann FC: Effect of complete and partial removal of the liver . Medicine 1927;6:419.Crossref 16. Mellinkoff SM, Tumulty PA: Hepatic hypoglycemia: Its occurrence in congestive heart failure . N Engl J Med 1952;247:745-750.Crossref 17. McFadzean AJS, Young TT: Hypoglycemia in primary carcinoma of the liver . Arch Intern Med 1956;98:720.Crossref 18. Papaioannou AN: Tumors other than insulinomas associated with hypoglycemia . Surg Gynecol Obstet 1966;123:1093-1099. 19. Nelson R, Burman SO, Kiani R, et al: Hypoglycemic coma associated with benign pleural mesothelioma . J Thorac Cardiovas Surg 1975;69:306-314. 20. Castro A, Florez L, Rozanski JJ, et al: Tumor associated hypoglycemia and elevated serum non-suppressible insulin-like activity . J Fla Med Assoc 1978;65:421-424. 21. Tsibris JCM, Raynor LO, Buhi CW, et al: Insulin receptors in circulating erythrocytes and monocytes from women on oral contraceptives or pregnant women near term . J Clin Endocrinol Metab 1980;51:711-717.Crossref 22. Puavilai G, MacCart JG, Domont LA, et al: Insulin resistance in human pregnancy: A post-receptor defect , abstracted. Clin Res 1979; 27:659. 23. Beck-Nielsen H, Kuhl C, Pederson O, et al: Decreased insulin binding to monocytes from normal pregnant women . J Clin Endocrinol Metab 1979;49:810-814.Crossref 24. Megyesi K, Kahn CR, Roth J, et al: Circulating NSILA-S in man: Preliminary studies of stimuli in vivo and of binding to plasma components . J Clin Endocrinol Metab 1975;41:475-484.Crossref 25. Bousvaros GA: Hypoglycemia in metastatic fibrosarcoma of the liver . Br Med J 1960;1:836-838.Crossref 26. Allen CTB, Imrie D: Hypoglycemia as a complication of removal of a pheochromocytoma . Can Med Assoc J 1977;116:363-364. 27. Wilkins GG, Schmidt N, Doll WA: Hypoglycemia following excision of pheochromocytoma . Can Med Assoc J 1977;116:367-368. 28. Khandekar, JD: Islet cell tumors of the pancreas: Clinico-biochemical correlations . Ann Clin Lab Sci 1979;9:212-215. 29. Dillon RS: Handbook of Endocrinology , ed 2. Philadelphia, Lea & Febiger, 1980, pp 201-202. 30. Stewart BH, Bravo EL, Haaga J, et al: Localization of pheochromocytoma by computed tomography . N Engl J Med 1978;299:460.Crossref 31. Frerichs H, Creutzfeldt W: Hypoglycemia: Insulin secreting tumors . J Clin Endocrinol Metab 1976;5:747-767.Crossref 32. Younus S, Soterakis J, Sossi AJ, et al: Hypoglycemia secondary to metastases to the liver: A case report and review of the literature . Gastroenterology 1977;72:334-337.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1982

References