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Related Experiment Videos

Hyperinsulinemic hypoglycemia associated with a neurofibrosarcoma.

S S Lyall, N J Marieb, J K Wise

    Archives of Internal Medicine
    |June 1, 1975
    PubMed
    Summary

    A posterior mediastinal tumor caused severe hypoglycemia by increasing insulin levels. Tumor removal normalized glucose and insulin, suggesting an extrapancreatic tumor stimulated beta cell secretion.

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    Area of Science:

    • Endocrinology
    • Oncology
    • Pathology

    Background:

    • Recurrent severe hypoglycemia can be caused by extrapancreatic tumors.
    • Neurofibrosarcomas are rare malignant tumors that can secrete hormones.
    • Understanding tumor-induced metabolic disturbances is crucial for patient management.

    Purpose of the Study:

    • To investigate the cause of recurrent hypoglycemia in a patient with a posterior mediastinal malignant neurofibrosarcoma.
    • To determine the relationship between the tumor and the patient's metabolic abnormalities.
    • To elucidate the mechanism of tumor-induced hyperinsulinemia and its effect on pancreatic alpha and beta cells.

    Main Methods:

    • Case study of a patient with posterior mediastinal malignant neurofibrosarcoma.
    • Repeated blood tests to measure plasma glucose and insulin levels.

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  • Assessment of pancreatic alpha and beta cell function through stimulation tests.
  • Tumor tissue analysis including insulin extraction and electron microscopy.

    • Main Results:

    • The patient presented with basal hyperinsulinemia and recurrent severe hypoglycemia.
    • No glucagon response to aminogenic stimulation was observed during hypoglycemia.
    • Tumor tissue analysis did not reveal immunoreactive insulin or beta-type secretory granules.
    • Post-tumor removal, plasma glucose and insulin levels normalized, and alpha cell function improved.

    Conclusions:

    • The findings suggest that the extrapancreatic neurofibrosarcoma stimulated pancreatic beta cell secretion.
    • The tumor may have also inhibited pancreatic alpha cell response.
    • Surgical removal of the tumor resolved the hypoglycemia and normalized metabolic parameters.
    • This case highlights a rare instance of tumor-induced hypoglycemia mediated by extrapancreatic factors.