BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor ...BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition.Herein,we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis.CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis,presented with altered mental status and dizziness.He was found to have severe hypoglycemia refractory to glucose supplements.Imaging studies and biopsy discovered well differentiated HCC without metastasis.Further evaluation showed low insulin,C-peptide and betahydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio,consistent with the diagnosis of NICTH.As patient was not a candidate for surgical resection or chemotherapy,he was started on prednisolone with some improvements in the glucose homeostasis,but soon decompensated after a superimposed hospital acquired pneumonia.CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal.Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC,even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.展开更多
BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia(NICTH).As NICTH is a rare lesion,the natural course of NICTH is not well understood.We report a case of N...BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia(NICTH).As NICTH is a rare lesion,the natural course of NICTH is not well understood.We report a case of NICTH that was observed 30 years before the onset of hypoglycemia.CASE SUMMARY A 50-year-old man was diagnosed with an abnormal right chest shadow during a routine X-ray examination,but no further examination was undertaken because the lesion appeared benign.Thirty years after the tumor discovery,the patient was admitted to the hospital with symptoms of severe hypoglycemia,which was diagnosed as NICTH based on a complete examination.The tumor was resected and found to be a solitary fibrous mass(15.6 cm×13.7 cm×10.4 cm);thereafter,the patient’s blood glucose levels normalized and he completely recovered.CONCLUSION NICTH can have an acute onset,even if the tumor has been present and asymptomatic over a long time period.展开更多
目的：探讨甘精胰岛素联合二甲双胍治疗对新诊断2型糖尿病（T2DM）伴非酒精性脂肪肝病（NAFLD）患者血糖和胰岛β细胞功能的影响。方法选取2012年6月～2013年12月在本院内分泌科门诊就诊的62例新诊断T2DM伴NAFLD患者作为研究对象，随机...目的：探讨甘精胰岛素联合二甲双胍治疗对新诊断2型糖尿病（T2DM）伴非酒精性脂肪肝病（NAFLD）患者血糖和胰岛β细胞功能的影响。方法选取2012年6月～2013年12月在本院内分泌科门诊就诊的62例新诊断T2DM伴NAFLD患者作为研究对象，随机分为治疗组（32例）和对照组（30例）。对照组给予二甲双胍联合格列美脲片，治疗组给予二甲双胍联合甘精胰岛素。比较两组治疗前后的FBG、2 h PG、HbA1c、FINS水平和胰岛β细胞功能指数。结果两组治疗12周后的FBG、2 h PG、HbA1c水平显著低于治疗前，差异有统计学意义（P〈0.05）。两组治疗12周后的FINS、HOMA-βF、△I30/△G30水平显著高于治疗前，差异有统计学意义（P〈0.05）。治疗组治疗后的FINS、HOMA-βF、△I30/△G30水平显著高于对照组治疗后，差异有统计学意义（P〈0.05）。结论甘精胰岛素或格列美脲片联合二甲双胍治疗均能改善T2DM伴NAFLD患者的血糖和早相胰岛素分泌，甘精胰岛素联合二甲双胍治疗能更有效地改善早相胰岛素分泌。展开更多
文摘BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition.Herein,we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis.CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis,presented with altered mental status and dizziness.He was found to have severe hypoglycemia refractory to glucose supplements.Imaging studies and biopsy discovered well differentiated HCC without metastasis.Further evaluation showed low insulin,C-peptide and betahydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio,consistent with the diagnosis of NICTH.As patient was not a candidate for surgical resection or chemotherapy,he was started on prednisolone with some improvements in the glucose homeostasis,but soon decompensated after a superimposed hospital acquired pneumonia.CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal.Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC,even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.
文摘BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia(NICTH).As NICTH is a rare lesion,the natural course of NICTH is not well understood.We report a case of NICTH that was observed 30 years before the onset of hypoglycemia.CASE SUMMARY A 50-year-old man was diagnosed with an abnormal right chest shadow during a routine X-ray examination,but no further examination was undertaken because the lesion appeared benign.Thirty years after the tumor discovery,the patient was admitted to the hospital with symptoms of severe hypoglycemia,which was diagnosed as NICTH based on a complete examination.The tumor was resected and found to be a solitary fibrous mass(15.6 cm×13.7 cm×10.4 cm);thereafter,the patient’s blood glucose levels normalized and he completely recovered.CONCLUSION NICTH can have an acute onset,even if the tumor has been present and asymptomatic over a long time period.
文摘目的：探讨甘精胰岛素联合二甲双胍治疗对新诊断2型糖尿病（T2DM）伴非酒精性脂肪肝病（NAFLD）患者血糖和胰岛β细胞功能的影响。方法选取2012年6月～2013年12月在本院内分泌科门诊就诊的62例新诊断T2DM伴NAFLD患者作为研究对象，随机分为治疗组（32例）和对照组（30例）。对照组给予二甲双胍联合格列美脲片，治疗组给予二甲双胍联合甘精胰岛素。比较两组治疗前后的FBG、2 h PG、HbA1c、FINS水平和胰岛β细胞功能指数。结果两组治疗12周后的FBG、2 h PG、HbA1c水平显著低于治疗前，差异有统计学意义（P〈0.05）。两组治疗12周后的FINS、HOMA-βF、△I30/△G30水平显著高于治疗前，差异有统计学意义（P〈0.05）。治疗组治疗后的FINS、HOMA-βF、△I30/△G30水平显著高于对照组治疗后，差异有统计学意义（P〈0.05）。结论甘精胰岛素或格列美脲片联合二甲双胍治疗均能改善T2DM伴NAFLD患者的血糖和早相胰岛素分泌，甘精胰岛素联合二甲双胍治疗能更有效地改善早相胰岛素分泌。
