Hypoglycemia
Differential Diagnosis
- Insulin over-production
- Insulinomas
- Insulin over-exposure
- Iatrogenic overdose
- Self-induced overdose
- Paraneoplastic syndromes
- IGF-2 overproduction by malignancies. This leads to increased glucose utilization by skeletal muscles and inhibition of gluconeogenesis, glycogenolysis, and glucose release in the liver.
- Nonislet cell tumours, which tend to be large (2-4 kg) and found in the thorax (1/3) or the retroperitoneum (2/3).
- Mesenchymal tumours
- Vascular tumours
- Epithelial cell types (ex. HCC)
- Doege-Potter Syndrome is a very rare paraneoplastic syndrome associated with Solitary Fibrous Tumours secondary to autonomous overproduction of IGF-2
- High-dose glucocorticoids (prendisone 20 mg or more daily) can reduce the production of IGF-2 in the tumour
- Nonislet cell tumours, which tend to be large (2-4 kg) and found in the thorax (1/3) or the retroperitoneum (2/3).
- IGF-2 overproduction by malignancies. This leads to increased glucose utilization by skeletal muscles and inhibition of gluconeogenesis, glycogenolysis, and glucose release in the liver.
References
- Nonislet cell tumor hypoglycemia - UpToDate
- Frontiers | Non-islet Cell Hypoglycemia: Case Series and Review of the Literature
- Solitary fibrous tumor - UpToDate
- https://www-nejm-org.libaccess.lib.mcmaster.ca/doi/pdf/10.1056/NEJMcpc2300899