Pancreatic neuroendocrine tumor with hypoglycemia and elevated insulin-like growth factor II: a case report

Abstract

Pancreatic neuroendocrine tumors (pNETs) can be associated with different clinical syndromes. Insulinoma is the most common functioning pNET characterized by hypoglycemia and hyperinsulinemia. The authors report a case of a man presenting with hypoglycemia and biochemical features of insulinoma. A pancreatic lesion was found and growth hormone (GH) deficiency was also diagnosed associated with an empty sella present on the pituitary magnetic resonance imaging. The disappearance of hypoglycemia and normalization of GH secretion after surgical resection of the pancreatic lesion, revealed a rare pNET secreting insulin-like growth factor II.

Keywords

Pancreatic neuroendocrine tumor / insulinoma / hypoglycemia / insulin-like growth factor II

References

[1] McKenna LR.Update on pancreatic neuroendocrine tumors..Gland Surg2014;3:258-75

[2] Fraenkel M,Faggiano A,Valk GD.Incidence of gastroenteropancreatic neuroendocrine tumours: a systematic review of the literature..Endocr Relat Cancer2014;21:153-63

[3] Okabayashi T,Sumiyoshi T,Ito S,Kobayashi M.Diagnosis and management of insulinoma..World J Gastroenterol2013;19:829-37 PMCID:PMC3574879

[4] Service FJ,O'Brien PC.Functioning insulinoma – incidence, recurrence, and long-term survival of patients: a 60-year study..Mayo Clin Proc1991;66:711-9

[5] De HerderWW,Scoazec JY,Klöppel G,Kwekkeboom DJ,Eriksson B,Rindi G,Ferone D and all other Frascati Consensus Conference participants..Well-Differentiated Pancreatic Tumor/Carcinoma: Insulinoma..Neuroendocrinology2006;84:183-8

[6] Cryer PE,Grossman AB,Montori VM,Service FJ.Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline..J Clin Endocrinol Metab2009;94:709-28

[7] Service FJ.Hypoglycemic disorders..N Engl J Med1995;332:1144-52

[8] Le Roith D.Tumor-induced hypoglycemia..N Engl J Med1999;341:757-8

[9] Marks V.Glucocorticoid therapy suppresses abnormal secretion of big IGF-II by non-islet cell tumours inducing hypoglycaemia (NICTH)..Clin Endocrinol (Oxf)1998;49:491-8

[10] Chung JO,Cho DH,Chung DJ.Hypoglycemia associated with the production of insulin-like growth factor II in a pancreatic islet cell tumor: a case report..Endocr J2008;55:607-12