Pinho Dos Santos Diana, Correia Rui, Carragoso Adelino, Casimiro Carlos, Lemos Ana
Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT.
Department of General Surgery, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT.
Cureus. 2021 Jan 23;13(1):e12878. doi: 10.7759/cureus.12878.
Non-islet cell tumor hypoglycemia is a rare paraneoplastic condition caused by an extra-pancreatic tumor. We report a rare case of hypoglycemia caused by a relapsing pelvic solitary fibrous tumor associated with Big-IGF-2 production. A 72-year-old woman was admitted to our hospital because of loss of consciousness and hypoglycemia. She had a history of ovarian solitary fibrous tumor, which has relapsed. From investigation, serum levels of insulin and C-peptide were suppressed; IGF-1 was slightly reduced and IGF-2 was within the normal range, but the IGF-2: IGF-1 ratio was elevated, indicating the presence of Big-IGF-2 secreting non-islet cell tumor. Contrast-enhanced computed tomography (CT) showed a large pelvic mass. She was then submitted to surgical resection of the mass, which histologically proved to be a solitary fibrous tumor. Three months later, she remains asymptomatic. Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and recurrent hypoglycemia.
非胰岛细胞瘤性低血糖症是一种由胰腺外肿瘤引起的罕见副肿瘤综合征。我们报告一例罕见的由复发的盆腔孤立性纤维瘤伴大IGF-2分泌引起的低血糖症病例。一名72岁女性因意识丧失和低血糖症入院。她有卵巢孤立性纤维瘤病史且已复发。经检查，血清胰岛素和C肽水平受到抑制；IGF-1略有降低，IGF-2在正常范围内，但IGF-2:IGF-1比值升高，提示存在分泌大IGF-2的非胰岛细胞瘤。增强计算机断层扫描（CT）显示盆腔有一巨大肿块。随后她接受了肿块的手术切除，组织学检查证实为孤立性纤维瘤。三个月后，她仍无症状。对于出现肿瘤和反复低血糖症的患者，鉴别诊断时应考虑非胰岛细胞瘤性低血糖症。
