Hirai Hiroyuki, Ogata Emi, Ohki Shinji, Fukuda Izumi, Tanaka Mizuko, Watanabe Tsuyoshi, Satoh Hiroaki
Department of Nephrology, Hypertension, Diabetology, Endocrinology, and Metabolism, Fukushima Medical University, Japan.
Intern Med. 2016;55(10):1309-14. doi: 10.2169/internalmedicine.55.5848. Epub 2016 May 15.
A 61-year-old woman with multiple metastatic and unresectable gastrointestinal stromal tumors (GISTs) was referred for investigation of refractory hypoglycemia that developed four months before this hospitalization. On admission, her fasting plasma glucose was 38 mg/dL despite 10% glucose infusion. Investigations revealed that her serum C-peptide, insulin and growth hormone levels were suppressed, and big insulin-like growth factor II was observed. She was diagnosed with non-islet cell tumor hypoglycemia, which resolved after glucocorticoid treatment. Clinicians should thus be vigilant to identify hypoglycemia in patients with large metastatic GISTs because glucocorticoid therapy is useful even if the GIST is inoperable.
一名61岁患有多处转移性且无法切除的胃肠道间质瘤（GIST）的女性因本次住院前四个月出现的难治性低血糖而前来接受检查。入院时，尽管输注了10%的葡萄糖，她的空腹血糖仍为38mg/dL。检查发现她的血清C肽、胰岛素和生长激素水平受到抑制，并观察到大量胰岛素样生长因子II。她被诊断为非胰岛细胞瘤低血糖症，经糖皮质激素治疗后病情缓解。因此，临床医生应警惕识别患有大面积转移性GIST患者中的低血糖情况，因为即使GIST无法手术，糖皮质激素治疗也是有效的。
