Causes and evaluation of tumor-induced hypoglycemia

Our plain-English summary of Causes and evaluation of tumor-induced hypoglycemia, by S.C. Immerman, S.F. Sener, J.D. Khandekar (Archives of Surgery, 1982).

The study

• Authors: S.C. Immerman, S.F. Sener, J.D. Khandekar
• Journal: Archives of Surgery
• Published: 1982;117(7):905-8
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We treated four patients who had hypoglycemia and nonpancreatic tumors. Two had pleural mesothelioma, one had primary fibrosarcoma of the liver, and one had pheochromocytoma metastatic to the liver. We propose four mechanisms for this syndrome: (1) insulin or insulin-like activity produced by the tumor, (2) decreased gluconeogenesis, (3) disruption of glucagon metabolism, and (4) increased utilization of glucose by the tumor. The local effects of the tumor in hepatic parenchyma may also play an important role. The important diagnostic tests are an insulin-glucose ratio, to rule out insulinoma, and fasting glucose levels. An assay of nonsuppressible insulin-like activity can be performed and is of investigative interest, but does not aid in individual patient therapy. Treatment consists of control of the tumor.

In plain English

This article reported four patients treated at Evanston Hospital who had dangerously low blood sugar (hypoglycemia) linked to tumors outside the pancreas. The authors then discussed possible causes and how to test such patients. Two patients had tumors of the pleura, the lining around the lungs. A 69-year-old man had a 1,060-g malignant fibrous mesothelioma of the pleura removed. His hypoglycemia resolved, and he was alive without disease nine years later. A 31-year-old woman was admitted one week after giving birth. Surgery found a 1,300-g fibrous mesothelioma in her right pleural space, and she was well two years later. A 59-year-old man had a spindle cell fibrosarcoma of the liver; surgery to remove it was attempted, but he died. A 62-year-old woman had a pheochromocytoma that had spread to the liver, with a blood glucose level of 10 mg/dL, and she died. The article did not mention asbestos. The authors concluded that the key tests are an insulin-glucose ratio, to rule out insulinoma, and fasting glucose levels, and that treatment consists of controlling the tumor.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series (four case reports) with the authors' discussion of mechanisms, diagnosis and treatment
• Who was studied: Four patients with hypoglycemia and nonpancreatic tumors treated at Evanston Hospital, Illinois: a 69-year-old man, a 31-year-old woman admitted one week after giving birth, a 59-year-old man and a 62-year-old woman. The dates of treatment are not given.
• Exposure: Not reported. The article does not mention asbestos or any fiber or occupational exposure. It concerns hypoglycemia associated with tumors.
• Main results:
  • Case 1 was a 69-year-old man admitted unconscious with a blood glucose level of 30 mg/dL. A 1,060-g malignant fibrous mesothelioma of the pleura was removed. His hypoglycemia resolved, and he was alive without disease nine years later. His assay for nonsuppressible insulin-like activity (NSILA) was normal.
  • Case 2 was a 31-year-old woman admitted one week after giving birth, with a serum glucose level of 30 mg/dL. She had a normal insulin level and normal NSILA findings. Exploratory surgery found a 1,300-g fibrous mesothelioma in the right pleural space, and she was well two years later.
  • Case 3 was a 59-year-old man with a blood glucose level of 29 mg/dL. He had a huge spindle cell fibrosarcoma of the liver. Surgical removal was attempted, but he died because of technical problems and coagulopathy. The authors stated that about 85% of his liver had been replaced by tumor.
  • Case 4 was a 62-year-old woman with pheochromocytoma that had spread to the liver. Her blood glucose level was 10 mg/dL and her insulin-glucose ratio was normal. She died, and autopsy showed almost complete replacement of the liver by tumor nodules.
• The authors' conclusion: The authors concluded that an insulin-glucose ratio (to rule out insulinoma) and fasting glucose levels are the key diagnostic tests. In their view, an NSILA assay is of research interest but does not aid individual patient therapy, and treatment consists of control of the tumor.
• Limitations the authors state:
  • In case 3, NSILA levels were not measured.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Parenchyma.

Related studies

• Malignant mesothelioma associated with hypoglycemia; report of a case — K.A. Nesbitt, J.T. Boswell, et al. (1958)
• Solitary fibrous tumor of the pleura. An immunohistochemical, electron microscopic and tissue culture study of a tumor producing insulin-like growth factor I in a patient with hypoglycemia — E.H. Strøm, F. Skjørten, et al. (1991)
• Giant pleural mesothelioma associated with hypoglycemia and hyperthyroidism — G.J. Devroede, A.F. Tirol (1968)
• Benign pleural mesothelioma with tumour-induced hypoglycaemia — K.R. Burgess, J. Rutland, et al. (1982)
• Clinical Evaluation of ErbB-Targeted CAR T-Cells, Following Intracavity Delivery in Patients with ErbB-Expressing Solid Tumors — S. Papa, M. van Schalkwyk, et al. (2015)
• Evaluation of (111)In labeled antibodies for SPECT imaging of mesothelin expressing tumors — R. Misri, K. Saatchi, et al. (2011)

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