Abstract
Tumor-induced hypoglycemia is a rare and serious complication that is usually a consequence of either excessive insulin secretion (insulinoma) or because of non-islet cell tumor hypoglycemia (NICTH). NICTH is a rare phenomenon seen most often in adult patients. It is associated with different tumor types. Here, we report the first case to the best of our knowledge in the literature of a pediatric patient with NICTH associated with desmoplastic small round cell tumor (DSRT). This is a 15-year-old girl who presented with symptomatic hypoglycemia and abdominal mass. She required an intravenous glucose infusion rate as high as 9 mg/kg/min in addition to glucose containing oral supplements in order to maintain her blood glucose above 60 mg/dL. Computed tomography (CT) scan of the chest, abdomen and pelvis showed multiple hepatic lesions with an intraperitoneal soft tissue mass which subsequently was diagnosed as DSRT. When the blood glucose was 45 mg/dL, the insulin, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels were suppressed with an appropriate elevation of cortisol. Subsequently, an insulin-like growth factor-2 (IGF-2) level was sent and the IGF-2:IGF-1 ratio was found to be elevated >10 consistent with NICTH. After the first dose of chemotherapy, hypoglycemia improved, and she was weaned off glucose containing fluids. NICTH should be considered in all cancer patients regardless of their age with refractory hypoglycemia.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 947-950 |
| Number of pages | 4 |
| Journal | Journal of Pediatric Endocrinology and Metabolism |
| Volume | 31 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 28 2018 |
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Keywords
- hypoglycemia
- oncology
- pediatric endocrinology
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Endocrinology, Diabetes and Metabolism
- Endocrinology
Cite this
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Refractory hypoglycemia in a pediatric patient with desmoplastic small round cell tumor. / Almaghraby, Abdullah; Brickman, Wendy Joy; Goldstein, Jeffrey Adam; Habiby, Reema L.
In: Journal of Pediatric Endocrinology and Metabolism, Vol. 31, No. 8, 28.08.2018, p. 947-950.Research output: Contribution to journal › Article
TY - JOUR
T1 - Refractory hypoglycemia in a pediatric patient with desmoplastic small round cell tumor
AU - Almaghraby, Abdullah
AU - Brickman, Wendy Joy
AU - Goldstein, Jeffrey Adam
AU - Habiby, Reema L
PY - 2018/8/28
Y1 - 2018/8/28
N2 - Tumor-induced hypoglycemia is a rare and serious complication that is usually a consequence of either excessive insulin secretion (insulinoma) or because of non-islet cell tumor hypoglycemia (NICTH). NICTH is a rare phenomenon seen most often in adult patients. It is associated with different tumor types. Here, we report the first case to the best of our knowledge in the literature of a pediatric patient with NICTH associated with desmoplastic small round cell tumor (DSRT). This is a 15-year-old girl who presented with symptomatic hypoglycemia and abdominal mass. She required an intravenous glucose infusion rate as high as 9 mg/kg/min in addition to glucose containing oral supplements in order to maintain her blood glucose above 60 mg/dL. Computed tomography (CT) scan of the chest, abdomen and pelvis showed multiple hepatic lesions with an intraperitoneal soft tissue mass which subsequently was diagnosed as DSRT. When the blood glucose was 45 mg/dL, the insulin, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels were suppressed with an appropriate elevation of cortisol. Subsequently, an insulin-like growth factor-2 (IGF-2) level was sent and the IGF-2:IGF-1 ratio was found to be elevated >10 consistent with NICTH. After the first dose of chemotherapy, hypoglycemia improved, and she was weaned off glucose containing fluids. NICTH should be considered in all cancer patients regardless of their age with refractory hypoglycemia.
AB - Tumor-induced hypoglycemia is a rare and serious complication that is usually a consequence of either excessive insulin secretion (insulinoma) or because of non-islet cell tumor hypoglycemia (NICTH). NICTH is a rare phenomenon seen most often in adult patients. It is associated with different tumor types. Here, we report the first case to the best of our knowledge in the literature of a pediatric patient with NICTH associated with desmoplastic small round cell tumor (DSRT). This is a 15-year-old girl who presented with symptomatic hypoglycemia and abdominal mass. She required an intravenous glucose infusion rate as high as 9 mg/kg/min in addition to glucose containing oral supplements in order to maintain her blood glucose above 60 mg/dL. Computed tomography (CT) scan of the chest, abdomen and pelvis showed multiple hepatic lesions with an intraperitoneal soft tissue mass which subsequently was diagnosed as DSRT. When the blood glucose was 45 mg/dL, the insulin, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels were suppressed with an appropriate elevation of cortisol. Subsequently, an insulin-like growth factor-2 (IGF-2) level was sent and the IGF-2:IGF-1 ratio was found to be elevated >10 consistent with NICTH. After the first dose of chemotherapy, hypoglycemia improved, and she was weaned off glucose containing fluids. NICTH should be considered in all cancer patients regardless of their age with refractory hypoglycemia.
KW - hypoglycemia
KW - oncology
KW - pediatric endocrinology
UR - http://www.scopus.com/inward/record.url?scp=85050944878&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050944878&partnerID=8YFLogxK
U2 - 10.1515/jpem-2018-0107
DO - 10.1515/jpem-2018-0107
M3 - Article
VL - 31
SP - 947
EP - 950
JO - Journal of Pediatric Endocrinology and Metabolism
JF - Journal of Pediatric Endocrinology and Metabolism
SN - 0334-018X
IS - 8
ER -