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When a nephrectomy cures hypoglycaemia.

Aonghus O'Loughlin¹, Frank Waldron-Lynch, Kevin Christopher Cronin

¹University Hospital Galway, Diabetes Mellitus, Newcastle Road, Galway, Ireland.

BMJ Case Reports

|June 21, 2011

Summary

This summary is machine-generated.

A rare renal sarcoma caused recurrent hypoglycemia by overproducing insulin-like growth factor II (IGF-II). Surgical removal of the tumor completely resolved the patient's hypoglycemic episodes, highlighting IGF-II as a key factor.

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Area of Science:

Endocrinology
Oncology
Nephrology

Background:

Non-islet cell tumor hypoglycemia (NICH) is a rare condition often caused by insulin or insulin-like growth factor (IGF) production.
Elevated IGF-II levels, particularly in relation to IGF-I, are implicated in NICH, but the association with renal tumors is seldom reported.

Purpose of the Study:

To report a unique case of NICH caused by a renal sarcoma secreting excess IGF-II.
To emphasize the diagnostic and therapeutic implications of identifying IGF-II-secreting tumors in NICH.

Main Methods:

A case study of a 40-year-old woman presenting with recurrent hypoglycemia.
Biochemical analysis including glucose, insulin, C-peptide, IGF-I, and IGF-II levels.
Abdominal and pelvic imaging (radiology).
Surgical intervention (radical nephrectomy) and histological examination of the tumor.

Main Results:

The patient experienced episodic hypoglycemia, vagueness, speech disturbance, and blurred vision, relieved by food.
Fasting induced hypoglycemia with neuroglycopenia, responsive to dextrose.
Biochemical tests showed suppressed insulin and C-peptide with an elevated IGF-II:IGF-I ratio.
A large left renal mass was identified and surgically removed.
Histopathology confirmed a renal sarcoma (grade 2/3).
Post-nephrectomy, all hypoglycemic episodes resolved completely.

Conclusions:

Renal sarcoma can be a rare cause of NICH through excessive IGF-II secretion.
This case highlights the importance of considering IGF-II-secreting tumors in the differential diagnosis of NICH.
Radical nephrectomy is an effective treatment for IGF-II-mediated hypoglycemia secondary to renal sarcoma.