Time curve of plasma glucose concentration(pg)serum. immunoreactive insulin(iri)after rapid intravenous injection

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2 Time curve of plasma glucose concentration(pg)serum immunoreactive insulin(iri)after rapid intravenous injection of 30 g glucose.solid line( œ)indicates preoperative data and doted line( )indicates postoperative data.

3 Time curve of plasma glucose concentration(pg; serum immunoreactive insulin(iri: \ )and serum C-peptide reactivity(cpr; in 75 g oral glucose tolerance test. Fig. 2-1 shows preoperative data and Fig. 2-2 shows postoperative data. Fig. 3 Time curve of plasma glucose concentration (PG; serum immunoreactive insulin (IRI: ---- ), and serum C-peptide reactivity (CPR; shows preoper- after a 1 mg intravenous injection of glucagon.fig.3-1 ative data and Fig. 3-2 shows postoperative data.

4 Changes in humoral factors and important metabolic parameters before and after tumorectomy. cf.pg=plasma glucose concentration,iri=imunoreactive insulin, CPR=C peptide reactivity,igf-i=insulin like growth factor I,IGF II=nsulin like growth factor-ii

6 Axelrod L (1989) Increased insulin-like growth factor II production and consequent suppression of growth hormone secretion: a dual mechanism for tumor-induced hypoglycemia. J Clin End Met 68: ) Kawai K, Suzuki S, Takano K, Hizuka N, Watanabe Y and Yamashita K (1990) Effects of insulin-like growth factor in insulin and glucagon 1) Fukuda I, Hizuka N, Takano K, Asakawa K, release from isolated perfused rat pancreas. Endocrinol Shizume K and Demura H (1993) Characterization Japan 37: of insulin-like growth factor 2 (IGF- H) and IGF binding proteins in patients with non-islet-cell tumor hypoglycemia. Endocrine J 40: ) Pun KK, Young TT, Wang CF, Tam CF and Ho PWM (1988) The use of glucagon challenge tests in 3) Daughaday WH (1991) Autocrine, paracrine and the diagnostic evaluation of hypoglycemia due to endocrine manifestations of insulin-like growth hepatoma and insulinoma. J. Clin. Endorinol. factor secretion by tumors. Modern concepts of Metab. 67: insulin-like growth factors. ed. by Spencer EM. 12) Silbert CK, Rossini AA, Ghazvinian S, Widrich WC, Elsevier Science Pub., Amsterdam: Marks LJ and Sawin CT (1976) Tumor hypoglycemia: 4) Shapiro ET, Bell G I, Polonsky S, Rubenstein H, deficient splanchnic glucose output and Kew MC and Tager HS (1990) Tumor hypoglycemia: deficient glucagon secretion. Diabetes 25: Relationship to high molecular weight 13) Teale JD and Marks V (1990) Inappropriately insulin-like growth factor 2. J. Cin. Inves 85: 1672 elevated plasma insulin like growth factor II in relation to suppressed insulin-like growth factor 1 5) Bar RS, Boes M, Clemmons DR (1990) Insulin in the diagnosis of nonislet cell tumour hypoglycemia. differentially alters transcapillary movement of Clin. Endocrinology 33: intravascular IGFBP1, IGFBP2 and endothelial cell IGF binding proteins in rat heart. Endocrinology 127: ) Ron D, Powers AC, Pandian MR, Godien JE and

7 Abstract A Case of Retroperitoneal Tumor with Hypoglycemia Yoshihiko Suzuki,Seiichirou Morinaga and Kempei Matsuoka Saiseikai Central Hospital,Tokyo A 50-year-old man was admitted with spontaneous hypoglycemia and retroperitoneal mesothelioma.as his fasting plasma IRI level was low,he was diagnosed as having non-islet-cell tumor hypoglycemia(nicth) He had a high blood concentration of insulin-like growth factor II(IGF-II),with an increase in the percentage of the large molecular weight form,as well as altered blood IGF II-IGF binding protein formation.his plasma IGF-I was also low.before tumorectomy,three types of insulin -secretion test were conducted.on the i.v.glucose loading test,the early phase of the insulin response was almost intact,but the later phase showed gradual suppression.on the oral glucose test, secretion was grossly suppressed.on the i.v.glucagon test,the response was completely suppressed. After tumorectomy,all of the above humoral factors and the results of the three tests returned to normal. These data suggest that heterogenous IGF-II is produced and that IGF binding proteins are altered in patients with NICTH.It was also noteworthy that,in the same patient,intrinsic insulin and its secretion were suppressed with variable responses to three different stimulations.these observations led us speculate that some unknown substance related to appropriate insulin suppression is involved,in an undefined way,in the pathogenesis of NICTH and the role of IGF-II. J.Japan Diab.Soc.36(12): ,1993

[ ] 169 NICTH Nadler WH Wolfer JA NICTH. (nonislet cell tumor. (hypoglycemia) (nonislet cell tumor hypoglycemia, NICTH)

[ ] 169 NICTH Nadler WH Wolfer JA NICTH. (nonislet cell tumor. (hypoglycemia) (nonislet cell tumor hypoglycemia, NICTH) [] 169 1 2 2 2 (nonislet cell tumor hypoglycemia, NICTH) (paraneoplastic syndrome) NICTH (macromolecules insulin-like growth factor-ii, big IGF-II)Big IGF-II (tumor burden) NICTH NICTH 2016; 26: 169-78