Paraneoplastic hypoglycemia: An overview for optimal clinical guidance

Nikolaos Nektarios Karamanolis , Dimitris Kounatidis , Natalia G. Vallianou , Konstantinos Alexandropoulos , Eleni Kovlakidi , Pinelopi Kaparou , Irene Karampela , Theodora Stratigou , Maria Dalamaga
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Abstract

Paraneoplastic hypoglycemia, also known as non-islet cell tumor hypoglycemia (NICTH), is a rare but critical condition occurring in patients with different types of malignancy. This condition is commonly linked to tumors producing insulin-like growth (IGF) factors, particularly IGF-2 and its precursors, which disrupt glucose homeostasis and lead to excessive glucose consumption. The diagnosis typically involves documenting symptomatic hypoglycemia and ruling out other potential causes. Essential diagnostic tools include imaging studies and laboratory tests, specifically measuring IGF-2 levels and the IGF-2:IGF-1 ratio. Treatment strategies for NICTH are multifaceted and may include surgical resection of the tumor if feasible, pharmacological interventions such as corticosteroids to suppress IGF-2 production, or supportive measures to manage acute hypoglycemic episodes. Novel therapeutic approaches targeting IGF-2, such as monoclonal antibodies or siRNA, are also being explored and hold promise for future treatment options. This review aims to enhance understanding of paraneoplastic hypoglycemia, focusing on its pathogenesis and diagnosis, to guide optimal medical treatment.

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副肿瘤性低血糖症:最佳临床指导概述
副肿瘤性低血糖症又称非胰岛细胞肿瘤性低血糖症(NICTH),是一种罕见但危重的病症,多发于不同类型的恶性肿瘤患者。这种情况通常与肿瘤产生胰岛素样生长因子(IGF)有关,尤其是 IGF-2 及其前体,它们会破坏葡萄糖稳态并导致葡萄糖消耗过多。诊断通常需要记录症状性低血糖并排除其他潜在原因。基本诊断工具包括影像学检查和实验室检测,特别是测量 IGF-2 水平和 IGF-2:IGF-1 比率。NICTH 的治疗策略是多方面的,可能包括在可行的情况下手术切除肿瘤、药物干预(如皮质类固醇)以抑制 IGF-2 的产生,或采取支持性措施来控制急性低血糖发作。针对 IGF-2 的新型治疗方法(如单克隆抗体或 siRNA)也在探索之中,有望成为未来的治疗选择。本综述旨在加深人们对副肿瘤性低血糖症的了解,重点关注其发病机制和诊断,以指导最佳的药物治疗。
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来源期刊
Metabolism open
Metabolism open Agricultural and Biological Sciences (General), Endocrinology, Endocrinology, Diabetes and Metabolism
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审稿时长
40 days
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