Hepatomas are a common
malignancy in countries with a high prevalence of hepatitis B virus
infections. These
tumors may present with severe persistent
hypoglycemia. We have studied the possible relationship of production of
insulin-like growth factor II (
IGF-II) by these
tumors and the development of
hypoglycemia. Mean
IGF-II concentration was not significantly higher in 23 patients with
hypoglycemia than in nine patients with euglycemia (542 +/- 61 [SE] micrograms/L vs 382 +/- 52 micrograms/L). Serum
IGF-I was more suppressed in patients with
hypoglycemia (16 +/- 3 micrograms/L) than in patients with euglycemia (57 +/- 18 micrograms/L). Because an increased percentage of
IGF-II in serum of patients with
hypoglycemia who have other
tumors is present as partially processed
pro-IGF-II ("big"
IGF-II), we passed sera of patients with
hypoglycemia and patients with euglycemia with
hepatomas through acidic Bio-Gel P-60 columns. We found that 57% +/- 4.6% of the
IGF-II in sera from patients with
hypoglycemia was present as big
IGF-II compared with 22% +/- 3% in patients with euglycemia with
hepatomas (not significantly different from that in normal controls). Four of 11 apparently healthy control subjects who were hepatitis B virus positive also had increased percentages of big
IGF-II, suggesting that abnormal processing of
pro-IGF-II may result from subtle changes in liver function with this
infection. It remains to be determined whether these subjects with increased big
IGF-II are at increased risk for the development of
hepatomas. In conclusion, we have confirmed marked suppression of
IGF-I in the sera of patients with
hepatoma and
hypoglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)