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肾细胞癌的范式转变：将低血糖症视为一种重要的副肿瘤综合征

A Paradigm Shift in Renal Cell Carcinoma: Recognizing Hypoglycaemia as a Significant Paraneoplastic Syndrome.

作者信息

S Madhumitha, T Deepankumar, Madhavan Krishnaswamy, C D Anand, Kumar Janardanan

机构信息

Department of General Medicine, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Chengalpattu, IND.

Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Chengalpattu, IND.

出版信息

Cureus. 2024 Nov 8;16(11):e73276. doi: 10.7759/cureus.73276. eCollection 2024 Nov.

DOI:10.7759/cureus.73276
PMID:39651031
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11625412/
Abstract

Recurrent hypoglycaemia is a rare paraneoplastic syndrome associated with several cancers, including renal cell carcinoma (RCC). Here we present a curious case of a patient with type 2 diabetes mellitus (T2DM) who had numerous hospitalisations due to recurrent hypoglycaemia. A well-defined lesion at the lower pole of the right kidney and bilateral pyelonephritis were found during imaging investigations. A biopsy from the lesion confirmed clear cell carcinoma of the kidney and the most probable cause of recurrent hypoglycemia was paraneoplastic syndrome related to RCC. Analysis of Insulin-like growth factor levels revealed that recurrent hypoglycaemia might be the result of non-islet cell tumor-hypoglycaemia (NICTH). This case emphasizes how crucial it is to rule out paraneoplastic syndromes like NICTH in individuals presenting with hypoglycaemia that cannot be explained, even when pre-existing diabetes is present. Furthermore, this study emphasizes the need to include RCC in the differential diagnosis.

摘要

复发性低血糖是一种罕见的副肿瘤综合征，与包括肾细胞癌（RCC）在内的多种癌症相关。在此，我们报告一例2型糖尿病（T2DM）患者的奇特病例，该患者因复发性低血糖多次住院。影像学检查发现右肾下极有一个边界清晰的病灶以及双侧肾盂肾炎。对该病灶进行活检确诊为肾透明细胞癌，而复发性低血糖最可能的原因是与RCC相关的副肿瘤综合征。胰岛素样生长因子水平分析显示，复发性低血糖可能是非胰岛细胞瘤性低血糖（NICTH）的结果。该病例强调了在出现无法解释的低血糖的个体中，即使存在既往糖尿病，排除像NICTH这样的副肿瘤综合征是多么关键。此外，本研究强调在鉴别诊断中需要考虑RCC。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/673ca1787b27/cureus-0016-00000073276-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/3b0f74d2714d/cureus-0016-00000073276-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/d1d21e653766/cureus-0016-00000073276-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/bd065883646a/cureus-0016-00000073276-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/69bc209acd24/cureus-0016-00000073276-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/673ca1787b27/cureus-0016-00000073276-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/3b0f74d2714d/cureus-0016-00000073276-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/d1d21e653766/cureus-0016-00000073276-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/bd065883646a/cureus-0016-00000073276-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/69bc209acd24/cureus-0016-00000073276-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cea8/11625412/673ca1787b27/cureus-0016-00000073276-i05.jpg

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本文引用的文献

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Endocrinol Diabetes Metab Case Rep. 2024 Mar 1;2024(1). doi: 10.1530/EDM-23-0089. Print 2024 Jan 1.
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肝癌伴副肿瘤性低血糖症：病例报告及文献综述
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Non-islet cell tumor hypoglycemia as an initial presentation of hepatocellular carcinoma coupled with end-stage liver cirrhosis: A case report and review of literature.非胰岛细胞瘤性低血糖症作为肝细胞癌合并终末期肝硬化的首发表现：一例病例报告及文献复习
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An Adrenocortical Carcinoma Associated with Non-Islet Cell Tumor Hypoglycemia and Aberrant ACTH Production.一例与非胰岛细胞瘤性低血糖症及异常促肾上腺皮质激素分泌相关的肾上腺皮质癌
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