Abstract
Weight loss as a result of cachexia with malignancy is frequently encountered in clinical practice. However, previous reports have not demonstrated weight gain in terminal phase of malignancy. We report a 69-year-old male admitted with an exacerbation of interstitial pneumonia and multiple metastases of relapsed gastric adenocarcinoma complicated with refractory hypoglycemia. He had gained approximately 10 kg weight with an acromegaloid appearance in a one-month period before admission. The presence of big insulin-like growth fact II (Big IGF-II) in his blood and an immunohistochemical study on the tumor cells confirmed a diagnosis of non-islet cell tumor hypoglycemia. This report possibly illustrates an unreported differential diagnosis of weight gain in terminal phase of malignancy.
Highlights
Weight loss as a result of cachexia with malignancy is frequently encountered in clinical practice
Nonislet cell tumor hypoglycemia (NICTH) is a rare condition of malignancy. It has been considered as a cause of refractory hypoglycemia, which results from an abnormal secretion of big insulin growth factorII (Big IGFII) from tumor cells
This case report describes significant weight gain with an acromegaloid appearance in a 69yearold male with NICTH associated with Big IGFII producing tumor in the terminal phase of gastric adenocarcinoma
Summary
It has been considered as a cause of refractory hypoglycemia, which results from an abnormal secretion of big insulin growth factorII (Big IGFII) from tumor cells This case report describes significant weight gain with an acromegaloid appearance in a 69yearold male with NICTH associated with Big IGFII producing tumor in the terminal phase of gastric adenocarcinoma. A 69yearold male with relapsed gastric adenocarcinoma (total gastrectomy and RouxenY reconstruction were performed in September 2009) and systemic metastases was admitted to our hospital for severe respiratory failure as a result of an acute exacerbation of interstitial pneumonia on June 22, 2011 He had gained approximately 10 kg weight with acromegaloid features in a onemonth period before his admission (Figures 1 and 2). Taking into account the detection of Big IGFII in his blood, the result of immunohistochemistry and refractory hypoglycemia, we made a final diagnosis of NICTH
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