Abstract
Non-islet cell tumor hypoglycemia (NICTH) is a rare but serious paraneoplastic syndrome in which a tumor secretes the high molecular weight form of IGF-II, causing hypoglycemia and requiring early diagnosis and management. Here, I report a rare case of NICTH caused by fibrosarcoma in a 94-year-old male with recurrent hypoglycemia. This case report describes the clinical presentation and diagnostic and management issues involved in a case of NICTH that was diagnosed at a tertiary care institute.
Highlights
Hypoglycemia can be caused by several tumors, including islet and non-islet cell tumors (NICTH). (1) Non-islet cell tumor hypoglycemia (NICTH) is a rare and serious type of tumor that secretes a high-molecular weight form of insulin-like growth factor (IGF)-II that stimulates insulin receptors and increases glucose utilization, causing hypoglycemia
Hypoglycemia can be caused by several tumors, including islet and non-islet cell tumors (NICTH). (1) NICTH is a rare and serious type of tumor that secretes a high-molecular weight form of IGF-II that stimulates insulin receptors and increases glucose utilization, causing hypoglycemia
The patient had diminished C peptide, insulin, insulin-like growth factor 1 (IGF-I) and IGF binding protein 3 levels; the total IGF-II level was within the normal range, and the molar ratio between the total IGF-II and IGF-I levels was 17.7
Summary
Hypoglycemia can be caused by several tumors, including islet and non-islet cell tumors (NICTH). (1) NICTH is a rare and serious type of tumor that secretes a high-molecular weight form of IGF-II that stimulates insulin receptors and increases glucose utilization, causing hypoglycemia. (1) NICTH is a rare and serious type of tumor that secretes a high-molecular weight form of IGF-II that stimulates insulin receptors and increases glucose utilization, causing hypoglycemia. NICTH occurs more commonly in patients with mesenchymal tumors, fibromas, carcinoid, myelomas, lymphomas, hepatocellular, and colorectal carcinoma table 1. NICTH is accompanied by serious complications, which is why I chose to report this case, as well as to remind clinicians of this cause of hypoglycemia. Case In 2012, a 94-year-old male with no risk factors for hypoglycemia was admitted to the emergency department with serum glucose of 1.6 mmol/l and a history of weight loss and recurrent episodes of autonomic and neuropsychiatric symptoms of hypoglycemia, which occurred regularly, in the mornings. A. The patient’s postoperative biochemical IGF, glucose, insulin,C peptide, and proinsulin levels returned to normal, and he experienced no further hypoglycemic episodes
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