BMC Endocrine Disorders (May 2020)

A case of insulin-like growth factor 2-producing gastrointestinal stromal tumor with severe hypoglycemia

  • Haruka Yamasaki,
  • Ayako Itawaki,
  • Miwa Morita,
  • Hitomi Miyake,
  • Masahiro Yamamoto,
  • Hiroki Sonoyama,
  • Sayuri Tanaka,
  • Masakazu Notsu,
  • Mika Yamauchi,
  • Yusuke Fujii,
  • Noriyoshi Ishikawa,
  • Izumi Fukuda,
  • Shunji Ishihara,
  • Keizo Kanasaki

DOI
https://doi.org/10.1186/s12902-020-0529-2
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 6

Abstract

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Abstract Background Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome that secretes incompletely processed high molecular weight insulin growth factor 2 (big-IGF2), which results in stimulation of the insulin receptor and subsequently induces hypoglycemia. Gastrointestinal stromal tumor (GIST) is a common intestinal mesenchymal neoplasm of the gastrointestinal tract. The most frequent site of GIST is the stomach; NICTH induced by IGF2-producing stomach GISTs is rare. Case presentation An 84-year-old man was admitted to the hospital due to impaired consciousness (JCS II-10) in the morning. At the time of admission, his serum glucose was 44 mg/dL; his consciousness was restored with 20 ml of 50% glucose. To avoid hypoglycemia, a continuous intravenous infusion of glucose as well as dietary intervention was required. At the time of hypoglycemia, the levels of insulin and C-peptide were suppressed. Additionally, IGF1 levels were below the normal range. Abdominal computed tomography revealed that he had a large lobulated mass (116 × 70 × 72 mm) around the gastric corpus. Pathological analysis of biopsy specimens identified disarray of spindle cells and positivity for c-kit as well as strong positivity for DOG-1. Further analysis revealed high levels of Ki-67 (Mib-1 index: 15.5%) and mitotic index (7/50HPF); the tumor was diagnosed as high-risk GIST, and complete surgical resection was performed. Hypoglycemia resolved immediately after tumor resection. The resected tumor specimen was positive for IGF2 staining, and big-IGF2 (11–18 kDa) was detected in preoperative serum and tumor samples; the patient was diagnosed with NICTH due to an IGF2-producing tumor. Conclusions NICTH is rare in GIST of the stomach; however, the large GIST could produce big-IGF2 and subsequently cause severe hypoglycemia, requiring prompt evaluation and complete tumor resection.

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