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Extreme Hypoglycaemia in Anaplastic Large Cell Lymphoma
Lidor Akavia1, Ilan Krause1,2
1Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
European Journal of Case Reports in Internal Medicine
|February 14, 2019
Summary
This case report details a rare instance of non-islet cell tumour hypoglycaemia (NICTH) caused by anaplastic large cell lymphoma. The findings highlight that haematological malignancies can exceptionally lead to NICTH through Insulin-like Growth Factor-2 (IGF-2) overproduction.
Area of Science:
- Endocrinology
- Oncology
- Hematology
Background:
- Non-islet cell tumour hypoglycaemia (NICTH) is a rare complication of extra-pancreatic malignancies, typically linked to large solid tumors.
- Anaplastic large cell lymphoma has not been previously associated with NICTH, making this report unique.
Purpose of the Study:
- To report the first documented case of NICTH in a patient with anaplastic large cell lymphoma.
- To investigate the underlying mechanism of severe hypoglycemia in this patient.
Main Methods:
- A 22-year-old patient presented with severe hypoglycemia (3 mg/dl), malaise, itching, night sweats, and weight loss.
- Investigations included measurement of serum glucose, insulin, C-peptide, and IGF-1 levels, alongside biopsies of inguinal lymph nodes and bone marrow.
- Diagnosis of anaplastic large cell lymphoma and haemophagocytic lymphohistiocytosis was confirmed.
Main Results:
- The patient exhibited extremely low serum glucose levels with undetectable insulin and C-peptide, and low IGF-1.
- Biopsies confirmed anaplastic large cell lymphoma and haemophagocytic lymphohistiocytosis.
- Findings indicated hypoglycemia due to overproduction of the high molecular weight IGF-2 precursor protein ('Big IGF-2').
Conclusions:
- This case demonstrates that NICTH, although exceptionally rare, can occur in non-solid malignancies like anaplastic large cell lymphoma due to 'Big IGF-2' overproduction.
- Hematological malignancies can secrete IGF-2 and 'Big IGF-2', leading to NICTH.
- Insulin, C-peptide, and IGF-1 levels are crucial for diagnosing NICTH.
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