Causes and evaluation of tumor-induced hypoglycemia
S. C. Immerman, S. F. Sener and J. D. Khandekar
We treated four patients who had hypoglycemia and nonpancreatic tumors. Two
had pleural mesothelioma, one had primary fibrosarcoma of the liver, and
one had pheochromocytoma metastatic to the liver. We propose four
mechanisms for this syndrome: (1) insulin or insulin-like activity produced
by the tumor, (2) decreased gluconeogenesis, (3) disruption of glucagon
metabolism, and (4) increased utilization of glucose by the tumor. The
local effects of the tumor in hepatic parenchyma may also play an important
role. The important diagnostic tests are an insulin-glucose ratio, to rule
out insulinoma, and fasting glucose levels. An assay of nonsuppressible
insulin-like activity can be performed and is of investigative interest,
but does not aid in individual patient therapy. Treatment consists of
control of the tumor.