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Ko, Kim, Maeng, Kim, Jang, Kim, Lee, Park, and Kang: A Case of Gastrointestinal Stromal Tumor with Recurrent Hypoglycemia
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2010; 25(2): 125-130.

Published online: 30 June 2010

DOI: https://doi.org/10.3803/EnM.2010.25.2.125

A Case of Gastrointestinal Stromal Tumor with Recurrent Hypoglycemia

Sun Hee Ko, Seok Hwan Kim, Il Ho Maeng, Koon Soon Kim, Yi Sun Jang, Hye Soo Kim, Jong Min Lee, Suk Young Park, Sang Bum Kang

Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Corresponding author: Koon Soon Kim. Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2 Daeheung-dong, Jung-gu, Daejeon 301-804, Korea. Tel: +82.42-220-9305, Fax: +82.42-252-6807, kunsunkim@catholic.ac.kr

Received 8 September 2009       Accepted 26 October 2009

Copyright © 2010 Korean Endocrine Society

Abstract

Non-islet cell tumor induced hypoglycemia (NICTH) is attributable to overproduction of insulin-like growth factor-II (IGF-II) by solid tumors, and these tumors usually originate from mesenchymal or epithelial cells. Gastrointestinal stromal tumor (GIST) is a rare mesenchymal tumor and most commonly find in the gastrointestinal tract. It is usually expresses the CD117 (stem cell factor receptor, c-kit) detected by immunohistochemistry. Hypoglycemia associated with GIST is very rare and this has not yet been reported in Korea. A 72-year-old man was hospitalized due to frequent episodes of confusion. It was observed that non-hyperinsulinemic hypoglycemia, an elevated serum IGF-II level and a huge liver mass. The histology of liver mass showed c-kit (CD117) positivity, which was consistent with GIST, but it was surgically unresectable. He was treated with imatinib mesylate. Although he recieved palliative treatment, he still experienced intermittent fasting hypoglycemia. After 2 months, the serum IGF-II level was even higher than before. We changed imatinib mesylate to sunitinib malate and performed radiotherapy on the liver mass. Although the change of the liver mass was not significant, he did not suffer from hypoglycemia for three months afterwards.

Keywords: Gastrointestinal stromal tumor (GIST), Insulin-like growth factor-II (IGF-II), Non-islet cell tumor induced hypoglycemia (NICTH)

Figures and Tables

Fig. 1
Early-enhanced (A), delayed-enhanced (B) computerized tomographic images of the abdomen. A huge mass lesion is noted in the liver.
enm-25-125-g001
Fig. 2
A. Pathologic finding of liver mass is composed of spindle-shaped tumor cells (H&E stain, × 100). B. Some mitoses were identified. The mitotic count was up to 16/10 high power field (H&E stain, × 400). C. C-kit immunohistochemical stain was positive. D. CD34 immunohistochemical stain was positive.
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Table 1
Hormonal tests performed during the first and second visits
enm-25-125-i001

IGF BP, Insulin like growth factor binding protein.

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