Abstract
Since Goege et al (1930) at first reported a case of giant fibrosarcoma with hypoglycemic attacks, many similar cases have been reported throughout the world. In all cases hypoglycemia had disappeared after the surgical removal of the tumor.
In this paper a case of giant mediastinal tumor with hypoglycemic attacks is presented and the pathological mechanism of hypoglycemia due to giant tumor is discussed. The patient was a 64-year-male. On january, 1969, he complained dyspnea and asthma attacks and 2 months later, he was admitted in to our hospital. X-ray findings of the chest showed a giant mediastial tumor and by thoracentesis 300 ml of transudate was obtained. Because the patient evaded the surgical operation, he was treated conservatively and discharged with marked improvement 4 months after admission.
Thereafter he was admitted 2 times because of the episodes of dyspnea and cyanosis. In a early morning 12 months after the onset, he had suddenly delirium and irritability and was admitted. After taking breakfast these symptoms completely disappeared and laboratory tests revealed low levels of blood glucose and IRI. The patient finally consented to remove the tumor surgically. The tumor was fortunately resected without residual. The resected tumor was 20 × 21 × 15 cm in size, weighed 3,100 g medullary and encapsulated. The pathological diagnosis of the tumor was fibromyoma. After the operation all clinical symptoms and abnormal laboratory findings disappeared and no recurrence was observed for 28 months.
Concerning the cause of hypoglycemic attaks associated with such a giant tumor, although many theories have been postulated, the authors would consider that the hypoglycemia should be attributed to the increasing glucose consumption and releasing a inhibitor of insulinase from the tumor in our case.
