2022 Volume 65 Issue 11 Pages 603-610
A 76-year-old woman underwent left pleural tumor resection at 70 years old and showed no recurrence for 3 years after the operation. However, she had to suspend her visits after this. At 76 years old, she was transported to our facility emergently due to hypoglycemia. Her intrinsic insulin secretion and blood insulin-like growth factor (IGF)-I levels were low during this hypoglycemic episode. However, no hepatic or renal dysfunction was observed, and the blood cortisol level was normal. Computed tomography showed a coarse mass in the left thoracic cavity. A Western blotting analysis of a serum sample demonstrated the presence of large-molecular-weight IGF-II. We therefore considered her hypoglycemia to be due to a large-molecular-weight IGF-II-producing extrapancreatic tumor. She did not wish to undergo surgery, so palliative care was given. We continued central intravenous feeding to avoid hypoglycemia, and the patient ultimately died on the 94th day of illness. At necropsy, immunostaining detected IGF-II and IGF-II receptors. The complex of large-molecular-weight IGF-II and IGF-II receptors may affect tumor development.
