Hypoglyceamia due to Paranoeplastic Secretion of Insulin in a Patient with Metastasizing Colon Cancer

Nadia Charfi¹, Lilia Affes¹, Mouna Elleuch^1, , Wafa Ben Saada¹, Nabila Rkik¹, Faten Hadj Kacem¹, Mouna Mnif¹, Fatma Mnif¹ and Mohamed Abid¹

¹Departement of Endocrinology, Diabetolgy, Hedi Chaker Hospital, Sfax, Tunisia

Cite this paper:
Nadia Charfi, Lilia Affes, Mouna Elleuch, Wafa Ben Saada, Nabila Rkik, Faten Hadj Kacem, Mouna Mnif, Fatma Mnif and Mohamed Abid. Hypoglyceamia due to Paranoeplastic Secretion of Insulin in a Patient with Metastasizing Colon Cancer. American Journal of Medical Case Reports. 2015; 3(2):34-36. doi: 10.12691/ajmcr-3-2-4

Abstract

Paraneoplastic hypoglycemia by insulin secreting is rarely described in literature. We review rare cases of paraneoplastic hypoglycemia due to insulin secreting non islet cell tumor diagnosed in a 51 years old patient. This man has an advanced colon cancer with hepatic metastasize. He was admitted in our department for frequent, severe, organic hypoglycemia. Hormonal finding showed elevated serum levels of insulin and c peptide associated with normal serum levels of IGF1 and IGF2. The patient was treated by diet, prednisolone, diazoxid and the metastasize was surgically removed. So that, Hypoglycemia disappeared quickly after the treatment.

Keywords:
Paraneoplastic hypoglycemia colon cancer insulin metastasize IGF1 IGF2

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References:

[1]	Kahn CR et al. The riddle of tumourhypoglycaemia revisited. ClinEndocrinol Metab; (1980) 9:335-360.
[2]	Jan Willem, B de Groot, Bart Rikhof. Non-islet cell tumour-induced hypoglycaemia: a review of the literature including two new cases. Endocrine-Related Cancer (2007); 14: 979-993.
[3]	Le Roith D et al. Tumor-induced hypoglycemia. N Engl J Med; (1999) 341: 757-758.
[4]	Marks V, Teale JD et al. Tumours producing hypoglycaemia. Endocr Relat Cancer; (1998) 5: 111-29.
[5]	Daughaday WH, Emanuele MA, Brooks MH, Barbato AL,Kapadia M, Rotwein P. Synthesis and secretion of insulin like growth factor II by a leiomyosarcoma with associated hypoglycemia.N Engl J Med (1988) 319: 1434-1440.
[6]	Baxter RC, Holman SR, Corbould A et al. Regulation of the insulin-like growth factors and their binding proteins by glucocorticoid and growth hormone in non-islet cell tumor hypoglycemia. Journal of Clinical Endocrinology and Metabolism; (1995)80: 2700-2708.
[7]	Jakob A, Meyer UA, Flury R, Ziegler WH, Labhart A, Froesch ER. The pathogenesis of tumour hypoglycaemia : blocks of hepatic glucose release and of adipose tissue lipolysis. Diabetologia; (1967)3: 506-514.
[8]	Zapf J, Futo E, Peter M, Froesch ER. Can “big” insulin-like growth factor II in serum of tumor patients account for the development of extrapancreatic tumor hypoglycemia? J Clin Invest; (1992) 90: 2574-2584.
[9]	Teale JD, Blum WF, Marks V. Alleviation of non-islet cell tumour hypoglycaemia by growth hormone therapy is associated with changes in IGF binding protein-3.Ann Clin Biochem; (1992) 29: 314-323.
[10]	LeRoith D.Insulin-like growth factors. N Engl J Med ; (1997)336 : 633-40.
[11]	Moller N, Blum WF et al. Basal and insulin stimulated substrate metabolism in tumour induced hypoglycaemia; evidence for increased muscle glucose uptake. Diabetologia; (1991) 34: 17-20.
[12]	Baxter RC. The role of insulin-like growth factors and their binding proteins in tumor hypoglycemia. Hormone Research; (1991) 46: 195-201.
[13]	Michael A. Nauck, Manfred Reinecke et al. Hypoglycemia due to Paraneoplastic Secretion of Insulin-Like Growth Factor-I in a Patient with Metastasizing Large-Cell Carcinoma of the Lung. The Journal of Clinical Endocrinology & Metabolism; (2007) 92 (5): 1600-1605.
[14]	Fukuda I, Hizuka N, Ishikawa Y et al. Clinical features of insulin-like growth factor-II producing non-islet-cell tumor hypoglycemia. Growth Horm IGF Res; (2006)16:211-216.
[15]	Roberto Díaz, Jorge Aparicio, Andrea Mendizábal. Paraneoplastic hyperinsulinism and secondary hypoglycaemia in a patient with advanced colon cancer: A rare association. World J Gastroenterol; (2008 March 28) 14(12): 1952-1954.
[16]	Leena Krishnan, John Clark. Non-islet cell tumour hypoglycaemia. BMJ Case Reports (2011).
[17]	Service FJ. Diagnostic approach to adults with hypoglycemic disorders. Endocrinol Metab Clin North Am; (1999) 28: 519-532.
[18]	Le Roith D. Tumor-induced hypoglycemia. N Engl J Med; (1999)341: 757-758.
[19]	Marks V, Teale JD. Tumours producing hypoglycaemia. EndocrRelat Cancer (1998); 5 : 111-29.
[20]	Bourcigaux N, A rnault-Ouary G, Christol R, e t al. Treatment of hypoglycemia using combined glucocorticoid and recombinant human growth hormone in a patient with a metastatic non-islet cell tumor hypoglycemia. Clin Ther; (2005) 27: 246-51.
[21]	Baxter RC, Holman SR, Corbould A et al. Regulation of the insulin-like growth factors and their binding proteins by glucocorticoid and growth hormone in non-islet cell tumor hypoglycemia. J Clin Endocrinol Metab; (1995)80: 2700-2708.
[22]	Binoux M, Hossenlopp P. Insulin-like growth factor (IGF) and IGF binding proteins: comparison of human serum and lymph. J Clin Endocrinol Metab ;( 1988) 67: 509-514.
[23]	de Groot JW, R ikhof B, van Doorn J, et al. Non-islet cell tumour-induced hypoglycaemia:a review of the literature including two new cases. EndocrRelat Cancer (2007); 14 : 979-93.
[24]	Drake WM, M iraki F, Siddiqi A, et al. Dose-related effects of growth hormone on IGF-I and IGF-binding protein-3 levels in non-islet cell tumour hypoglycaemia.Eur J Endocrinol; (1998)139: 532-6.
[25]	Perros P, Simpson J, Innes JA et al. Non-islet cell tumour-associated hypoglycaemia: 111 In-octreotide imaging and efficacy of octreotide, growth hormone and glucocorticosteroids. Clinical Endocrinology (1996); 44 727-731.