Vol 21. N°4. 2020  |  Diciembre de 2020


CASO CLÍNICO - DIABETES


SÍNDROME HIPOGLUCÉMICO ASOCIADO A TUMOR SOLITARIO PULMONAR. REPORTE DE CASO


Autores: LETICIA FERRO, ANALÍA YAMAGUCHI, PABLO R. COSTANZO, LEÓN LITWAK


RESUMEN

El síndrome paraneoplásico de Doege-Potter (SDP) se asocia a la presencia de tumores intratorácicos y diafragmáticos que generan un cuadro de hipoglucemia por excesivo consumo de glucosa por parte del tumor, y aumento de producción de IGF-2 (insulin growth factor 2) con mayor captación de glucosa periférica.
Comunicamos el caso de una paciente femenina de 57 años, sin antecedentes de diabetes ni ingestión de fármacos hipoglucemiantes, que ingresó por un cuadro de hipoglucemia severa con glucemia de 38 mg/dL. Otros resultados: péptido C 1,05 ng/mL, insulinemia 10,5 uUI/mL, IGF-1 de 174 ng/mL, cortisol y prolactina normales. No disponíamos del dosaje de IGF-2. Ecografía abdominal sin patología evidente. Se inició alimentación rica en carbohidratos complejos. Continuó con hipoglucemias. A raíz de cervicalgia, se solicitó radiografía cervical y de tórax, evidenciándose opacidad en vértice izquierdo. La tomografía de tórax informó proceso pulmonar atípico. Por punción se diagnosticó carcinoma pulmonar pobremente diferenciado. Se inició quimioterapia, con reducción del tumor, y de la frecuencia y magnitud de las hipoglucemias. Concluimos que frente a cuadros de hipoglucemia en ausencia de factores causales debería sospecharse la presencia de un SDP.

PALABRAS CLAVE: tumores intratorácicos; hipoglucemia; Doege-Potter.

REFERENCIAS:
1. Service FJ. Classification of hypoglycemic disorders. Endocrinol Metab Clin North Am 1999; 28:501-17.
2. Doege KW. Fibro-sarcoma of the mediastinum. Ann Surg 1930; 92:955-60.
3. Roy TM, Burns MV, Overly DJ, et al. Solitary fibrous tumor of the pleura with hypoglycemia: the Doege-Potter syndrome. J Ky Med Assoc 1992; 90:557–60.
4. Schutt RC, Gordon TA, Bhabhra R, et al. Doege-Potter syndrome presenting with hypoinsulinemic hypoglycemia in a patient with a malignant extrapleural solitary fibrous tumor: a case report. J Med Case Rep 2013; 7:11.
5. Frystyk, J, Skjaerbaek C, Zapf J, et al. Increased levels of circulating free insulin-like growth factors in patients with non-islet cell tumour hypoglycaemia. Diabetologia 1998;41: 589–94.
6. Briselli M, Mark EJ, Dickersin GR. Solitary fibrous tumors of the pleura: eight new cases and review of 360 cases in the literature. Cancer 1981; 47:2678–89.
7. England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura. Am J Surg Pathol 1989; 13:640–58.
8. Caruso ES, Brandolino M, Pomi J, et al. Mesotelioma pleural localizado asociado a hipoglucemia. Comunicación de 2 casos y recopilación de la literatura. Rev Argent Cirug 1994; 66:189-95.
9. Chick JF, Chauhan NR, Madan R. Solitary fibrous tumors of the thorax: nomenclature, epidemiology, radiologic and pathologic findings, differential diagnoses, and manage-ment. Am J Roentgenol 2013; 200(3):W238-48.
10. Fung EC, Crook MA. Doege-Potter syndrome and 'big-IGF2': a rare cause of hypoglycaemia. Ann Clin Biochem 2011; 48:95–6.
11. Lee CE, Zanariah H, Masni M, et al. Solitary fibrous tumour of the pleura presenting with refractory non-insulin mediated hypoglycaemia (the Doege-Potter syndrome). Med J Malaysia 2010; 65:72–4.




SEVERE HYPOGLYCEMIA ASSOCIATED WITH SOLITARY PULMONARY TUMOR. CASE REPORT

SUMMARY

Doege-Potter (SDP) is a paraneoplastic syndrome mostly associated with big intrathoracic or diaphragmatic tumors, causing hypoglycemia in non-diabetic patient due to an increased glucose consumption by the tumor cells and excessive production of IGF-2 (insulin growth factor 2).
Case report: 57-year-old female patient without diabetes mellitus and not receiving hypoglycemic drugs who was assisted by severe hypoglycemia (38 mg/dL) with the following laboratory tests: C peptide 1.05 ng/mL, 10.5 uIU/mL insulinemia, 174 ng/mL IGF-1, normal cortisol and prolactin. IGF-2 was not available. Non-pathological abdominal ultrasound. In spite of a feeding rich in complex carbohydrate continued with hypoglycaemia. She started with neck pain and a cervical and chest X-ray was requested, which shows opacity in the left vertex. Chest tomography reported atypical lung process. The biopsy reported poorly differentiated carcinoma of the lung. After treatment with chemotherapy a reduction in tumor size and less episodes of hypoglycemia were observed. Conclusion: in the event of recurrent hypoglycaemia and in the absence of known etiologies we should consider the presence of SDP.

Key words: intrathoracic tumors; hypoglycemia; Doege-Potter.



DESCARGAR TEXTO COMPLETO EN PDF