1. Treatment of hypoglycemia using combined glucocorticoidand recombinant human growth hormone in a patient with a metastatic non-islet cell tumor hypoglycemia
- Author
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Gwenaëlle Arnault-Ouary, N. Bourcigaux, Bernard Charbonnel, Yves Le Bouc, R. Christol, and Laurence Périn
- Subjects
Blood Glucose ,medicine.medical_specialty ,Pleural Neoplasms ,Recurrent hypoglycemia ,medicine.medical_treatment ,Fibroma ,Hypoglycemia ,Prednisone ,Internal medicine ,Humans ,Insulin ,Medicine ,Pharmacology (medical) ,Insulin-Like Growth Factor I ,Adverse effect ,Glucocorticoids ,Aged ,Pharmacology ,biology ,Human Growth Hormone ,business.industry ,Liver Neoplasms ,medicine.disease ,Recombinant Proteins ,Somatropin ,Insulin-Like Growth Factor Binding Protein 3 ,Endocrinology ,Insulin-like growth factor 2 ,biology.protein ,Drug Therapy, Combination ,Female ,business ,Glucocorticoid ,medicine.drug - Abstract
Background: Non-islet cell tumor hypoglycemia(NICTH) is a rare cause of recurrent hypoglycemia. It has been associated with the tumoral overproduction of high-molecular-weight insulin-like growth factor (IGF)-2 (“big IGF-2”). Big IGF-2 suppresses growth hormone (GH) biosynthesis and impairs the storage of IGFs by suppressing the formation of the GH-dependent ternary complexes containing IGF, IGF binding protein 3 (IGFBP-3), and acid-labile subunit (ALS). Thus, big IGF-2 exerts hypoglycemic activity. The only effective treatment of NICTH is surgery. However, in inoperable patients with NICTH, treatment of hypoglycemia may require high doses of glucocorticoid (30–60 mg/d [0.5–1.0 mg/kg·d]) or recombinant human GH (rhGH) (2.6–12.0 mg/d [0.043–0.20 mg/kg·d]). Objective: We hypothesized that the association of low doses of glucocorticoid and rhGH could be an effective therapy for hypoglycemia in inoperable patients with NICTH. Methods: A 3-phase treatment regimen was conducted in an inoperable 67-year-old woman with NICTH. Decreasing dosages of prednisone (from 30 to 10 mg/d [from 0.50 to 0.15 mg/kg·d]), followed by decreasing doses of rhGH (from 2.6 to 1.3 mg/d [from 0.043 to 0.016 mg/kg·d]), and then a combination of the lowest doses of each, were tested. Glucose, insulin, and IGF monitoring were performed at each of the 3 treatment phases. Results: Fasting plasma glucose (FPG) level was normalized and the IGF-1 concentration was increased with high-dose prednisone monotherapy (30 mg/d [0.50 mg/kg·d]) or rhGH (2.6 mg/d [0.043 mg/kg·d]). Prednisone monotherapy partially suppressed big IGF-2 secretion, and rhGH monotherapy acted on IGFBP-3 and ALS concentrations. FPG level was normalized with combined low-dose prednisone and rhGH, and this combination was more effective than high-dose monotherapy with either drug in reestablishing the IGF system. No adverse effects (AEs) were found. Conclusions: In this patient with inoperable NICTH, the combination of low doses of prednisone and rhGH was a successful long-term therapy for hypoglycemia, with no AEs. This therapy could be proposed for use in patients with inoperable NICTH.
- Published
- 2005