Chillo Anthony J, Homsy Sylvester, Thida Aye M, Chiu Edwin
Hematology and Oncology, State University of New York Downstate Health Sciences University, Brooklyn, USA.
Hematology and Oncology, Stanford University School of Medicine, Stanford, USA.
Cureus. 2024 Dec 25;16(12):e76372. doi: 10.7759/cureus.76372. eCollection 2024 Dec.
Non-islet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome associated with non-mesenchymal-derived and epithelial tumors. A 37-year-old male with stage IVB hepatocellular carcinoma (HCC) and pulmonary metastases presented with recurrent hypoglycemia despite glucose supplementation. Laboratory findings revealed low insulin growth factor 1 (IGF-1) (15 ng/mL), elevated insulin growth factor 2 (IGF-2) (395 ng/ml), and an IGF-2:IGF-1 ratio of 26:1, consistent with NICTH. After ruling out other causes of hypoglycemia, including endocrine deficiencies and medication-induced hypoglycemia, the patient was managed with steroids and intravenous (IV) glucose. Due to the metastatic nature of the cancer, he was treated with atezolizumab and bevacizumab. Palliative radiation therapy (RT) was initiated to improve glycemic control. Following RT, hypoglycemic episodes decreased, allowing discharge with oral steroids. NICTH management remains challenging due to limited therapeutic options and variable treatment responses. Surgical resection is the standard treatment for NICTH; however, conservative approaches include steroid use, glucose supplementation, and recombinant growth hormone (GH). In this case, radiation was chosen to target the tumor and alleviate hypoglycemia, resulting in improved glycemic stability post-treatment. NICTH associated with HCC is a rare and challenging complication with significant morbidity. Early use of RT alongside systemic treatment may offer a viable strategy for managing NICTH and improving patient outcomes.
非胰岛细胞瘤性低血糖症（NICTH）是一种与非间充质来源的上皮性肿瘤相关的副肿瘤综合征。一名37岁的男性，患有IVB期肝细胞癌（HCC）并伴有肺转移，尽管补充了葡萄糖仍反复出现低血糖症。实验室检查结果显示胰岛素生长因子1（IGF-1）水平低（15 ng/mL），胰岛素生长因子2（IGF-2）水平升高（395 ng/ml），IGF-2与IGF-1的比值为26:1，符合NICTH的表现。在排除了低血糖的其他原因，包括内分泌缺陷和药物性低血糖后，该患者接受了类固醇和静脉注射葡萄糖治疗。由于癌症的转移性，他接受了阿替利珠单抗和贝伐单抗治疗。开始进行姑息性放射治疗（RT）以改善血糖控制。放疗后，低血糖发作次数减少，患者可以口服类固醇出院。由于治疗选择有限且治疗反应各异，NICTH的管理仍然具有挑战性。手术切除是NICTH的标准治疗方法；然而，保守方法包括使用类固醇、补充葡萄糖和重组生长激素（GH）。在本病例中，选择放疗来靶向肿瘤并缓解低血糖，从而使治疗后血糖稳定性得到改善。与HCC相关的NICTH是一种罕见且具有挑战性的并发症，发病率很高。早期将放疗与全身治疗联合使用可能为管理NICTH和改善患者预后提供一种可行的策略。
