Phuphanich S, Jacobs L, Poulos J E, Vesely D L
Department of Neurology, University of South Florida Health Sciences Center, Tampa, USA.
Am J Med Sci. 1995 Jun;309(6):317-21. doi: 10.1097/00000441-199506000-00004.
Hypoglycemia secondary to a meningioma that has not metastasized to the liver has not been reported previously. A 41-year-old woman with a spinal cord meningioma first diagnosed 5 years previously with 3 recurrences in the spinal cord resulting in 4 neurosurgical procedures was admitted with a serum glucose of 23 mg/dL. Six months before the current admission, the patient was noted to have an abdominal mass of 10 cm not present on previous computed tomography. Three months later, the mass was 15.2 cm, and on the current admission, had increased to 23 cm and encased both the aorta and inferior vena cava. A needle biopsy of this mass before referral to the authors' hospital with hypoglycemia revealed that it was a meningioma. Evaluation of the etiology of the hypoglycemia, which required continuous intravenous glucose therapy, revealed that circulating insulin, C-peptide (i.e., connecting peptide), insulin-like growth factor-I (i.e., somatomedin-C) and insulin-like growth factor-II were all normal or low. Serum cortisol also was not low. Based on her endocrine evaluation, the hypoglycemia was secondary to the large mass of tumor cells, requiring a large glucose uptake to sustain its growth. After radiation therapy of 3,770 CGy to the meningioma, the patient became euglycemic without glucose supplementation.
此前未曾报道过未转移至肝脏的脑膜瘤继发低血糖症的情况。一名41岁女性，5年前首次诊断为脊髓脑膜瘤，脊髓复发3次，接受了4次神经外科手术，此次因血清葡萄糖水平为23 mg/dL入院。本次入院前6个月，发现患者腹部有一个10 cm的肿块，之前的计算机断层扫描未显示该肿块。3个月后，肿块大小为15.2 cm，此次入院时已增大至23 cm，包绕了主动脉和下腔静脉。在因低血糖转诊至作者所在医院之前，对该肿块进行的针吸活检显示为脑膜瘤。对需要持续静脉输注葡萄糖治疗的低血糖病因进行评估发现，循环胰岛素、C肽（即连接肽）、胰岛素样生长因子-I（即生长调节素-C）和胰岛素样生长因子-II均正常或偏低。血清皮质醇也不低。根据其内分泌评估，低血糖继发于大量肿瘤细胞，肿瘤需要摄取大量葡萄糖来维持生长。对脑膜瘤进行3770 cGy的放射治疗后，患者无需补充葡萄糖血糖恢复正常。
