Alkaissi Hussam R, Mostel Zachary, McFarlane Samy I
Internal Medicine, Kings County Hospital Center, Brooklyn, USA.
Internal Medicine, Veterans Affairs Medical Center, Brooklyn, USA.
Cureus. 2022 Jun 10;14(6):e25813. doi: 10.7759/cureus.25813. eCollection 2022 Jun.
Severe hypoglycemia occurs with different types of tumors, including islet cell and non-islet cell tumors. Non-islet cell tumor hypoglycemia (NICTH) is a rare and potentially life-threatening complication of malignancy. The primary underlying mechanism of NICTH proposed in the literature includes paraneoplastic overproduction of insulin-like growth factor-2 (IGF-2), the production of autoantibodies against insulin or its receptors, or the presence of extensive metastatic burden replacing hepatic tissue or adrenal glands. In this report, we propose a potentially novel mechanism underlying NICTH involving stimulation of the insulin signaling pathway in a 58-year-old woman with a rare ovarian tumor of Müllerian origin that carries a duplication of the AKT2 gene. AKT2 is a molecular mediator of insulin signaling. To our knowledge, this is the first reported case of tumor-induced hypoglycemia associated with AKT2 gene duplication. In this report also, we discuss the currently available diagnostic modalities and highlight the therapeutic rationale in patients with NICTH, a highly vulnerable population.
严重低血糖症可发生于不同类型的肿瘤，包括胰岛细胞瘤和非胰岛细胞瘤。非胰岛细胞瘤低血糖症（NICTH）是一种罕见的、可能危及生命的恶性肿瘤并发症。文献中提出的NICTH的主要潜在机制包括副肿瘤性胰岛素样生长因子-2（IGF-2）过度产生、针对胰岛素或其受体的自身抗体产生，或广泛的转移瘤负荷取代肝组织或肾上腺。在本报告中，我们提出了一种潜在的NICTH新机制，该机制涉及在一名患有罕见的苗勒氏起源卵巢肿瘤且携带AKT2基因重复的58岁女性中刺激胰岛素信号通路。AKT2是胰岛素信号的分子介质。据我们所知，这是首例报道的与AKT2基因重复相关的肿瘤诱导性低血糖症病例。在本报告中，我们还讨论了目前可用的诊断方法，并强调了NICTH患者（一个高度脆弱的群体）的治疗原理。
