| Hyperinsulinemic hypoglycemia associated with ectopic Cushing's syndrome due to a pancreatic endocrine tumor in a Type 2 diabetes mellitus patient: Clinical implications of a rare association. | |
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MedLine Citation:
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PMID: 20386090 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: The coexistence of insulin and ACTH hypersecretion in the same patient is extremely rare. A diabetic patient with a pancreatic endocrine tumor (PET) co-secreting insulin and ACTH is even rarer and has never been described. The combination of these two endocrine syndromes results in a peculiar clinical picture. AIM: To determine the cause of glycemic variations in a patient with previously stable diabetes mellitus. SUBJECTS AND METHODS: This is a clinical case report from the Endocrinology Unit of Aosta Hospital and Internal Medicine and Surgical Unit of Verona University. A 69-yr-old diabetic patient was hospitalized for recurrent severe hypoglycemic events persistent after withdrawal of anti-diabetic drugs. The causes of hypoglycemia and subsequent resumption of hyperglycemia were investigated. RESULTS: An insulin-secreting PET was diagnosed. Diazoxide and octreotide therapy initially was able to control hypoglycemic symptoms, then, a Cushing's syndrome occurred resulting in worsening of diabetes control. ACTH was found to be released by the PET previously diagnosed as an insulin-secreting tumor. The tumor was removed and the histology was consistent with a well differentiated endocrine carcinoma. After surgery, adrenal function was normal and insulin therapy was again necessary to control diabetes. CONCLUSIONS: A single PET may be responsible for both a hyperinsulinemic and a Cushing's syndrome. When this rare association occurs, each of the two syndromes may affect the other resulting in a peculiar clinical course. Finally, an insulin-secreting PET has to be kept in mind as a rare cause of hypoglycemia in diabetic patients. |
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Authors:
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M Filippella; M V Davì; G Doveri; E Lillaz; A Ciccarelli; E Massimetti; M Toaiari; M Falconi; A Colao; A Faggiano |
Publication Detail:
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Type: Journal Article Date: 2010-04-12 |
Journal Detail:
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Title: Journal of endocrinological investigation Volume: 34 ISSN: 1720-8386 ISO Abbreviation: J. Endocrinol. Invest. Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-05-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7806594 Medline TA: J Endocrinol Invest Country: Italy |
Other Details:
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Languages: eng Pagination: 175-9 Citation Subset: IM |
Affiliation:
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S.C. Internal Medicine Unit of Diabetology and Endocrinology, "Parini" Hospital, Aosta, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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