Tamburrano G, Tamburrano S, Natoli C, Di Mario U, Andreani D
Diabete Metab. 1979 Dec;5(4):287-91.
A case of carcinoma of the stomach associated with severe hypoglycemia is reported. Diagnosis of insulinoma was excluded on the basis of history as well as laboratory tests. Postmortem examination revealed widespread small metastases to various organs; no metastasis was found in the pancreas; the histology of this gland did not show any pathological finding. No impairment in pituitary, thyroid, adrenal and liver function was detected. Fasting blood sugar ranged from 18 to 56 mg/100 ml. An oral glucose tolerance test showed a diabetic pattern with low insulin. Tolbutamide, glucagon and glucose injected i.v. gave only a moderate rise in plasma insulin levels; plasma glucagon response to arginine was subnormal. The determination of NSILA-s and gastrin in the serum of this patient gave normal values. Diazoxide infusion induced an increase in blood glucose and subsequent treatment with diazoxide relieved hypoglycemia for some months. The occasional detection of an islet cell antibody by immunofluorescence in this case is not easily understandable, but it might partly account for the carbohydrate intolerance. An impairment in gluconeogenesis dependent upon some substrate deficiency might account for the hypoglycemia in this patient.
报告一例伴有严重低血糖的胃癌病例。根据病史及实验室检查排除了胰岛素瘤的诊断。尸检发现全身各器官有广泛的小转移灶；胰腺未发现转移；该腺体的组织学检查未显示任何病理改变。未检测到垂体、甲状腺、肾上腺及肝功能受损。空腹血糖范围为18至56mg/100ml。口服葡萄糖耐量试验显示为糖尿病型且胰岛素水平低。静脉注射甲苯磺丁脲、胰高血糖素和葡萄糖仅使血浆胰岛素水平适度升高；血浆胰高血糖素对精氨酸的反应低于正常。该患者血清中NSILA-s和胃泌素的测定值正常。静脉输注二氮嗪可使血糖升高，随后用二氮嗪治疗使低血糖缓解了数月。该病例中偶尔通过免疫荧光检测到胰岛细胞抗体，这一点难以理解，但可能部分解释了碳水化合物不耐受的原因。依赖某些底物缺乏的糖异生受损可能是该患者低血糖的原因。
