The effectiveness of different treatment options for non-islet cell tumour hypoglycaemia

• Published in: Clinical endocrinology (Oxford) 2004-04, Vol.60 (4), p.457-460
• Main Authors: Teale, J. D., Wark, G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood Glucose - analysis; C-Peptide - blood; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Human Growth Hormone - therapeutic use; Humans; Hypoglycemia - blood; Hypoglycemia - drug therapy; Hypoglycemia - etiology; Insulin - blood; Insulin-Like Growth Factor I - analysis; Insulin-Like Growth Factor II - analysis; Male; Medical sciences; Middle Aged; Neoplasms - complications; Neoplasms - drug therapy; Neoplasms - surgery; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Protein Precursors - analysis; Vertebrates: endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2004.01989.x

Summary objective  To compare the outcome of different treatment options used in several cases of non‐islet cell tumour hypoglycaemia (NICTH). patients  Eight cases of NICTH were referred for diagnosis and monitoring following either surgical or medical treatment. methods  Serum samples collected throughout the time‐course of each case were analysed for glucose, insulin, C‐peptide, IGF‐I, total IGF‐II, total IGF‐II to IGF‐I ratio and, in most of the cases, big IGF‐II. results  Surgical excision was successful in the relief of symptoms and normalization of the biochemical parameters. Therapeutic treatment with glucocorticoids confirmed previous studies showing the suppressive effect on tumour (big) IGF‐II production. The present data show that the effect was dose‐dependent and reversible if doses were below a critical level. conclusions  Within the limits of the cases studied, and the time‐scales involved, moderate‐ to high‐dose glucocorticoid therapy had immediate beneficial influence on symptomatic hypoglycaemia and, if tolerated in the long term, was effective in correcting the underlying biochemical dysfunction, unlike other therapeutic regimens. This effectiveness was only achieved when the dose exceeded a threshold level specific to the patient. In addition, reduction of the dose or withdrawal of the drug caused a return of the abnormal biochemical profile. Surgical removal of the malignancy, where this was an option, was successful within the periods studied.