Hypoglycemia due to Ectopic Secretion of Insulin-Like Growth Factor-I in a Patient with an Isolated Sarcoidosis of the Spleen

Yuiko OGIWARA; Seijiro MORI; Mizuki IWAMA; Motoji SAWABE; Minoru TAKEMOTO; Nobuo KANAZAWA; Koh FURUTA; Izumi FUKUDA; Yoshitaka KONDO; Yoshiyuki KIMBARA; Yoshiaki TAMURA; Yuko CHIBA; Atsushi ARAKI; Koutaro YOKOTE; Naoki MARUYAMA; Hideki ITO

doi:10.1507/endocrj.K09E-370

ORIGINALS

Hypoglycemia due to Ectopic Secretion of Insulin-Like Growth Factor-I in a Patient with an Isolated Sarcoidosis of the Spleen

Yuiko OGIWARA ^†, Seijiro MORI ^†, Mizuki IWAMA ^†, Motoji SAWABE ^†, Minoru TAKEMOTO ^†, Nobuo KANAZAWA ^†, Koh FURUTA ^†, Izumi FUKUDA ^†, Yoshitaka KONDO ^†, Yoshiyuki KIMBARA ^†, Yoshiaki TAMURA ^†, Yuko CHIBA ^†, Atsushi ARAKI ^†, Koutaro YOKOTE ^†, Naoki MARUYAMA ^†, Hideki ITO ^†

著者情報

Yuiko OGIWARA ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Seijiro MORI ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Mizuki IWAMA ^†
Molecular Regulation of Aging, Research Team for Functional Biogerontology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Motoji SAWABE ^†
Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Minoru TAKEMOTO ^†
Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Nobuo KANAZAWA ^†
Department of Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Koh FURUTA ^†
Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Izumi FUKUDA ^†
Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women’s Medical University, Tokyo, Japan
Yoshitaka KONDO ^†
Molecular Regulation of Aging, Research Team for Functional Biogerontology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Yoshiyuki KIMBARA ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Yoshiaki TAMURA ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Yuko CHIBA ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Atsushi ARAKI ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
Koutaro YOKOTE ^†
Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Naoki MARUYAMA ^†
Molecular Regulation of Aging, Research Team for Functional Biogerontology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Hideki ITO ^†
Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
著者の貢献

†Yuiko OGIWARA, Seijiro MORI, Mizuki IWAMA, Motoji SAWABE, Minoru TAKEMOTO, Nobuo KANAZAWA, Koh FURUTA, Izumi FUKUDA, Yoshitaka KONDO, Yoshiyuki KIMBARA, Yoshiaki TAMURA, Yuko CHIBA, Atsushi ARAKI, Koutaro YOKOTE, Naoki MARUYAMA, Hideki ITOは本研究に等しく貢献した。

キーワード: Hypoglycemia, Sarcoidosis, Insulin-like growth factor-I

ジャーナルフリー

2010 年 57 巻 4 号 p. 325-330

DOI https://doi.org/10.1507/endocrj.K09E-370

View "Advance Publication" version (January 16, 2010).

詳細

抄録

Hypoglycemia is reported to be one of the manifestations of a patient with hypothalamic sarcoid infiltrates due to impaired counter-regulation of glucose. But, without hypothalamic lesion, patients with sarcoidosis would not be expected to have hypoglycemia. We recently identified a patient with an isolated sarcoidosis of the spleen who had experienced frequent fasting hypoglycemia which completely disappeared after splenectomy. During hypoglycemia, serum insulin was undetectable. Endocrinological examination revealed no abnormality. The objective was to investigate whether the patient’s hypoglycemia was due to ectopic secretion of an insulin-mimetic factor by the splenic sarcoidosis. Serum insulin-like growth factor-I (IGF-I) and IGF-II were measured by RIA. Serum visfatin and free IGF-I were by ELISA. A high molecular weight form of IGF-II, termed “big” IGF-II, was identified by Western blotting. Tissue IGF-I was quantified by real time RT-PCR after RNA extraction. Before operation, total and free serum IGF-I, serum IGF-II and serum visfatin were within reference range. Big IGF-II was not detected in patient’s serum extract. After operation, hypoglycemia did not recur and serum insulin returned to normal, while serum IGF-I decreased by half the preoperative level. RT-PCR revealed that mRNA level of IGF-I in the sarcoidosis tissue was about 1.8-fold greater than that in the normal spleen tissue. These data suggest that ectopic secretion of IGF-I by the splenic sarcoidosis and its direct access to the liver via the portal vein might cause fasting hypoglycemia mainly by suppressing hepatic gluconeogenesis.

責任著者(Corresponding author)

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