| 英文摘要 |
Nonislet cell tumor hypoglycemia (NICTH) denotes the syndrome of hypoglycemia produced by any neoplasm other than an insulinoma. Hepatocellular carcinomas are one of the most common neoplasms which result in NICTH, a rare but life-threatening paraneoplastic syndrome in need of early diagnosis and treatment. The major cause of NICTH is tumoral overproduction of incompletely processed insulinlike growth factor II, termed "big" IGF-II, which can stimulate insulin receptors and exhibits insulin-like activities. Moreover, big IGF-II also suppresses glucagon and growth hormone release. The net result is continued glucose utilization and inhibition of glucose release, glycogenolysis, and gluconeogenesis in the liver. Other potential but less common causes of NICTH include the production of autoantibodies against insulin or the insulin receptor and extensive tumor burden resulting in destruction of the liver or adrenal glands. The mainstay of treatment for NICTH is surgical resection, which is curative for hypoglycemia if resection is complete. When the underlying malignancy cannot be treated, medical therapy is required to prevent recurrent hypoglycemia symptoms. Other than oral glucose and/or IV glucose- or dextrose-containing fluids, glucocorticoids, glucagon, or recombinant human growth hormone (rhGH) can be added to control intractable hypoglycemia. The case report presents a 28-yearold man of hepatocellular carcinoma with refractory hypoglycemia. Epidemiology, pathophysiology, clinical manifestation, diagnosis, and treatment of NICTH are also introduced after literature review. |
