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2017 ; 2017
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Pro-IGF2-induced hypoglycaemia associated with hepatocellular carcinoma
#MMPMID28567293
van den Berg SAA
; Krol CG
Endocrinol Diabetes Metab Case Rep
2017[]; 2017
(ä): ä PMID28567293
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We present a patient (87 years, female) who was admitted to the emergency
department because of loss of consciousness. Previous medical history included
advanced-stage hepatocellular carcinoma and associated weight loss. She was found
on the ground in an unresponsive state by her daughter and was determined to be
hypoglycaemic. Upon bolus administration of 100?mL intravenous glucose (10%),
glucose levels increased to 2.9?mmol/L and the patient regained full
consciousness. She was admitted to the hospital for further examination, and
treatment and continuous intravenous glucose infusion was initiated. As the
patient was known to suffer from advanced-stage hepatocellular carcinoma,
tumour-associated hypoglycaemia was suspected. Insulin, c-peptide and IGF1
concentrations were indeed low, cortisol concentration was high and IGF2 and
Pro-IGF2 were borderline low and borderline high normal respectively. IGF2:IGF1
ratio was 23, confirming the diagnosis of non-islet cell tumour hypoglycaemia.
During the initial phase of treatment, euglycaemia was maintained by continuous
variable glucose infusion (5%, varying between 1 and 2?L/24?h), and the patient
was advised to eat small snacks throughout the day. After euglycaemia was
established and the diagnosis was confirmed, prednisolone was started (30?mg,
1?dd) and glucose infusions were halted. Under prednisolone treatment, glucose
levels were slightly increased and no further hypoglycaemic episodes occurred. At
her request, no surgery was performed. After 19 days, the patient was discharged
to a hospice and died 3 weeks later. LEARNING POINTS: Hepatocellular carcinoma
may be associated with non-islet cell tumour hypoglycaemia (NICTH).NICTH-induced
hypoglycaemia is associated with low insulin and IGF1.Measurement of IGF2 only
(without measurement of Pro-IGF2 and IGF1) may be insufficient to prove NICTH.