A case of nonislet cell tumor hypoglycemia associated with malignant mesothelioma requiring a multifaceted approach for optimal glycemic control

Our plain-English summary of A case of nonislet cell tumor hypoglycemia associated with malignant mesothelioma requiring a multifaceted approach for optimal glycemic control, by M. Ono, Y. Maeda, N. Koyama, et al (Clinical Case Reports, 2021).

The study

• Authors: M. Ono, Y. Maeda, N. Koyama, T. Nagase, Y. Katsura, H. Nakamura, K. Aoshiba
• Journal: Clinical Case Reports
• Published: 2021;9(10):e05028
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Nonislet tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome characterized by refractory hypoglycemia, which often requires multifaceted therapy. We reported a case of a patient with pleural malignant mesothelioma and developed NICTH, for which chemotherapy, glucocorticoids, and nutrition were given to achieve optimal glycemic control.

© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

In plain English

This article was a case report about one patient: a 77-year-old Japanese man with diabetes, admitted to a hospital in Japan after a week of breathlessness on exertion. He had worked as a builder and had a history of asbestos exposure 50 years earlier. The article did not name the type of asbestos. He also had a long smoking history. Tests on fluid from around the right lung led to a diagnosis of malignant mesothelioma, and he was given carboplatin and pemetrexed chemotherapy. On day 47 he developed low blood sugar (57 mg/dl), which kept returning even after his diabetes drugs were stopped. A blood test showed that most of a hormone called IGF II was in a large, incompletely processed form ("big IGF II"). This confirmed nonislet cell tumor hypoglycemia, a rare tumor-related condition. His doctors controlled his blood sugar with chemotherapy, corticosteroids, bedtime cornstarch and later intravenous feeding. He died of respiratory failure 204 days after admission. The authors concluded that this condition should be considered in tumor patients with unexplained low blood sugar, and that a combined treatment approach may be needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 77-year-old Japanese man with a 10-year history of well-controlled diabetes mellitus, admitted to Tokyo Medical University Ibaraki Medical Center, Japan, with a one-week history of dyspnea on exertion
• Exposure: Occupation was builder, with a history of asbestos exposure 50 years earlier (fiber type not stated). He also smoked cigarettes, 0.75 packs per day for 57 years.
• Main results:
  • Pleural fluid tumor cells were positive for CK 5/6 and calretinin and negative for TTF1, napsin A, p40 and desmin, which indicated malignant mesothelioma. Imaging showed diffuse right-sided pleural thickening and enlarged mediastinal lymph nodes, with no evidence of distant metastasis.
  • At 47 days after admission the patient had hypoglycemia with a blood glucose of 57 mg/dl. It recurred even after his hypoglycemic agents were withdrawn.
  • Fasting tests in this patient showed insulin below 0.1 μU/ml (normal 5 to 15) and low IGF I of 30 ng/ml (normal 48 to 177). Anti-insulin antibodies were undetectable.
  • Western blot of the patient's serum showed that most IGF II peptides were big IGF II (approximately 25 kDa), allowing a final diagnosis of nonislet cell tumor hypoglycemia (NICTH). The tumor cells also stained positive for IGF II.
  • After two courses of carboplatin and pemetrexed combined with hydrocortisone 40 mg/day, the hypoglycemia resolved and serum big IGF II decreased, at 69 days after admission.
  • Because the tumor grew despite chemotherapy, increasing corticosteroid doses were needed to control hypoglycemia: up to 30 mg/day prednisolone and 400 mg/day hydrocortisone. He also took uncooked cornstarch (dextrin) at bedtime.
  • Chemotherapy was stopped after five courses because of poor general condition. The hypoglycemia then worsened, and intravenous hyperalimentation was started.
  • The patient died of respiratory failure 157 days after the first hypoglycemic episode (204 days after admission).
• The authors' conclusion: The authors concluded that NICTH should be considered in patients with tumors and hypoglycemia without clear cause. Because complete tumor removal is not feasible in most mesothelioma cases, they wrote that managing NICTH may require a multifaceted approach: anticancer drugs, corticosteroids, nutrition, uncooked cornstarch and hyperalimentation.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chemotherapy.

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