Tumor Hypoglycemia Mediated by Igf-1 Effects in Non-Beta Cell Tumor

Abstract

Summary: Introduction: Tumor hypoglycemia is an uncommon manifestation that can occur in advanced hepatocarcinoma, through various mechanisms associating tumor production of IGF -1 and IGF-2.

Case presentation: We detail the clinical case of a woman diagnosed with hepatocarcinoma BCLC stage C Child Pugh class A with recurrent events of hypoglycemia during her clinical evolution, with biochemical studies that included glucose, insulin, C-peptide, cortisol and IGF-1. The patient presented low insulin and C-peptide levels ruling out a corresponding insulin cause to hypoglycemia. IGF-1 levels below the percentile were reported, suggestive of hypoglycemia mediated by dysregulation of the GH/IGF axis. Due to persistence of hypoglycemia events with Prednisone she is switched to dexamethasone presenting a significant clinical improvement with resolution of hypoglycemia episodes.

Conclusions: Patients with advanced hepatocarcinoma and non-insulin hypoglycemia (insulin levels and low C-peptide) should be suspected in IGF-mediated etiologies.

Although measured by IGF-2 is the most frequent, low IGF-1 levels can show an alteration of the GH/IGF axis in the tumor context. The use of glucocorticoids in this case is highlighted as it showed that there is no improvement in the hypoglycemia episodes with oral glucose supplementation or with parenteral glucose solutions