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Severe hypoglycemia associated with insulin-like growth factor II-producing liver metastasis from gastric carcinoma treated with overnight total parenteral nutrition via a central vein catheter reserve port.

Abstract
Hypoglycemia caused by insulin-like growth factor II is difficult to control. A 77-year-old woman was diagnosed with gastric cancer and multiple liver metastases in September 2006 and underwent chemotherapy; however, at that time there were no symptoms of hypoglycemia. From January 2007 onwards, hypoglycemic comas and symptoms of hypoglycemia began to appear frequently. Her serum level of insulin was normal; thus, we suspected the presence of big insulin-like growth factor II was causing the hypoglycemia. This was proven by Western immunoblotting and we diagnosed non-islet cell tumor hypoglycemia associated with gastric cancer. Overnight nutrition provided via a central venous catheter port to prevent hypoglycemia allowed the patient to become ambulant and to remain free of hypoglycemic coma at follow-up until her death 7 months later.
AuthorsYohei Koizumi, Atsushi Hiraoka, Kojiro Michitaka, Nayu Tazuya, Misa Ichiryu, Hiromasa Nakahara, Hironori Ochi, Atsushi Tanabe, Satoshi Hidaka, Akihiro Kodama, Takahide Uehara, Aki Hasebe, Yasunao Miyamoto, Tomoyuki Ninomiya, Teru Kumagi, Masanori Abe, Bunzo Matsuura, Norio Horiike, Yoichi Hiasa, Morikazu Onji
JournalClinical journal of gastroenterology (Clin J Gastroenterol) Vol. 4 Issue 2 Pg. 68-72 (Apr 2011) ISSN: 1865-7257 [Print] Japan
PMID26190708 (Publication Type: Journal Article)

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