Exp Clin Endocrinol Diabetes 2000; Vol. 108(8): 515-518
DOI: 10.1055/s-2000-11007
Case Report

© Johann Ambrosius Barth

Primary malignant fibrous histiocytoma of the lung: IGF-II producing tumor induces fasting hypoglycemia

B. L. Herrmann1 , B. Saller1 , W. Kiess2 , K. Morgenroth3 , K. Drochner4 , T. Schröder5 , K. Mann1
  • 1 Devision of Endocrinology, Department of Medicine, University of Essen, Germany
  • 2 Department of Pediatrics, University of Leipzig, Germany
  • 3 Department of Pathology, University of Bochum, Germany
  • 4 Department of Radiology, University of Essen, Germany
  • 5 Department Thoracical surgery, Ruhrlandklinik Essen, Germany
Further Information

Publication History

Publication Date:
31 December 2000 (online)

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Summary:

Augmented glucose utilisation or secretion of insulin-like-growth-factor II (IGF-II) are discussed as important pathogenetic factors in tumor-associated hypoglycemia (Doege-Potter Syndrome) with suppressed insulin and C-peptide levels. Primary malignant fibrous histiocytoma of the lung is an uncommon neoplasia and its association with hypoglycemia is rare and the causal relationship remains unclear. - We report a 57-year-old male with spontaneous hypoglycemia (1.67 mmol/l) due to a primary malignant fibrous histiocytoma of the lung, secreting IGF-II. Insulin (0.10 nmol/l; normal range 0.33-1.2) and C-peptide (3.0 mIU/l; 5-25) levels were suppressed in combination with low levels of growth hormone (< 0.5 ng/ml; < 7 ng/ml) and IGF-I (< 66.0 ng/ml; 70-246). The elevated IGF-II level (787 ng/ml; 300-500) and decreased IGF-binding protein 3 (1.6 mg/l; 2-5) indicated a high free IGF-II activity. After surgery (resection of the right upper lobe), glucose (4.4 mmol/l), insulin (9.0 mIU/L) and C-peptide (0.84 nmol/l) levels returned to normal. Serum IGF-I (289 ng/ml) and the IGF-I/IGF-II ratio (< 0.08 preoperative vs. 0.41 postoperative; > 0.20) increased to the normal reference range. - In conclusion, malignant fibrous histiocytoma (MFH) is rarely described presenting as tumor-induced hypoglycemia. Doege-Potter Syndrome in MFH seems to be related to tumor-associated IGF-II production.