Tumour-Induced Hypoglycaemia: A Mini-review of Diagnostics and Treatment of This Rare Case of Hypoglycaemia
摘要
Tumour-induced hypoglycaemia is one of the rare causes of hypoglycaemia. The most common causes include endogenous hypersecretion of insulin by the B cells of the islets of Langerhans themselves—Islet Cell Tumour Hypoglycaemia (ICTH). However, some tumours can lead to paraneoplastic hypoglycaemia by the production of substances interfering with glucose metabolism—Non-Islet Cell Tumour Hypoglycaemia (NICTH). NICTH usually occurs in patients with solid tumours of mesenchymal or epithelial origin, less frequently with haematological and neuroendocrine tumours. Diagnosis of tumour-induced hypoglycaemia is often late and challenging as it may manifest several years after diagnosis and treatment of the tumour, but on the other hand, it may also precede the diagnosis of the tumour itself.
Hypoglycaemia that is not associated with diabetes mellitus (DM) and/or its treatment is not a common clinical disorder Iglesias (Euro J Endocrinol 170:147–157, 2014), Mohammedi (Endocrinol Diabetes Metab, 2014), Groot (Endocrine-Related Cancer 14:979–993, 2007). In people without DM, hypoglycaemia is defined as a venous plasma glucose value of less than 3 mmol/l, which is accompanied by the Whipple triad: (1) clinical signs of hypoglycaemia, (2) low plasma glucose concentration, (3) resolution of symptoms after plasma glucose correction Iglesias (Euro J Endocrinol 170:147–157, 2014), Soutelo (Arch Endocrinol Metab 61: 98–102, 2017). Cancer is a rare cause of paraneoplastic hypoglycaemia Mohammedi (Endocrinol Diabetes Metab, 2014).
Tumour-induced hypoglycaemia (TIH) is a rare cause of hypoglycaemia that can occur due to excessive or reduced insulin secretion. The pathogenic mechanisms include (1) hypersecretion of insulin by a pancreatic tumour of B cells in the islets of Langerhans—insulinoma (Islet Cell Tumour Hypoglycaemia—ICTH) or hyperplasia of B cells—nesidioblastosis (NIPHS – Non Insulinoma Pancreatogenous Hypoglycaemic Syndrome) or ectopic insulin production, (2) infiltration of the liver or adrenal glands by a tumour, and (3) production of substances that interfere with glucose metabolism in non-B cell (non-pancreatic) tumours (Non-Islet Cell Tumour Hypoglycaemia—NICTH), including antibodies against insulin receptors (e.g., in haematological malignancies). The pathogenetic mechanisms of TIH are listed in Table