April - June 2022, Volume 18, Issue 2

Gherbon A, Frandes M, Nicula M, Avram A, Timar R

IGF-2 Induced Hypoglycemia Associated with Lung Sarcoma

Acta Endo (Buc) 2022, 18 (2): 232-237
doi: 10.4183/aeb.2022.232

Hypoglycemia from a non-insulin-secreting extrapancreatic tumor is a paraneoplastic syndrome characterized by the tumor production of a substance with an insulin-like effect (insulin-like growth factor 1 or 2 - IGF 1 or 2). Diagnosis is confirmed by the determination of IGF-1 and IGF-2 and finding an elevated IGF - 2/IGF- 1 ratio. The availability of these tests is limited in many laboratories, so prompt recognition and therapies are late. We present the case of a 70-year-old patient diagnosed with right lower lobe bronchopulmonary neoplasm who presented to the emergency department with an altered general condition and hypoglycemic coma. The evaluation revealed low levels of insulin and C-peptide along with an elevated IGF-2/IGF-1 ratio of more than 10, suggesting a diagnosis of lung sarcoma with production of IGF-2. Because the tumor could not be resected in this case, chemotherapy and radiotherapy were performed, along with glucocorticoid therapy to prevent recurrent hypoglycemia. In the case of a patient with lung sarcoma and recurrent hypoglycemia (especially severe hypoglycemia or coma), extrapancreatic non-hyperinsulinemic hypoglycemia should be determinate tumor IGF-2 secretion.

Keywords: non-insulin secreting extrapancreatic tumor, hypoglycemia, lung sarcoma, IGF-2.

Correspondence: Mirela Frandes MD, “Victor Babes” University of Medicine and Pharmacy, Functional sciences, 2 Eftimie Murgu Square, Timisoara, 300041, Romania, E-mail: mirela.frandes@umft.ro