Pazopanib-associated secondary adrenal insufficiency in a patient with malignant solitary fibrous tumor

Introduction Pazopanib is an agent that is being successfully used in soft tissue sarcomas. Some endocrine side effects may develop during pazopanib treatment. Here, we presented a case diagnosed with secondary adrenal insufficiency while being investigated for etiology of hypoglycemia which developed after pazopanib. Case report A 69-year-old male patient was operated in June 2019 due to a lung mass 26 × 18 × 10 cm in size. Pathological diagnosis revealed a solitary fibrous tumor with malignant behavior. The patient received three lines of chemotherapy. After pazopanib treatment, a hypoglycemic attack was reported. Management and outcome: Blood cortisol and ACTH (Adrenocorticotropic hormone) levels were not increased at the time of the hypoglycemic attack, and levels of other pituitary hormones were found to be normal. Electrolyte levels were in normal range. Since the counteracting hormone did not reach a sufficient level, it was considered secondary adrenal insufficiency. Hypoglycemic attacks did not occur during follow-up while taking steroid therapy and pazopanib. Discussion A single case of primary adrenal insufficiency has been reported in the literature. We here present a case who developed hypoglycemia after pazopanib and was diagnosed with drug-associated secondary adrenal insufficiency. When hypoglycemia develops during pazopanib treatment, we must be aware of adrenal insufficiency.

Big Insulin-like Growth Factor 2–Producing Tumor in a Hypoglycemic Dog

A 10-year-old female Papillon dog that had previously developed a mammary tumor was admitted for treatment of a hypoglycemic attack. Blood examination showed severe hypoglycemia and decreased blood insulin concentration. Computed tomography indicated multiple tumors in the cranial and caudal lobes of the right lung. These tumors were resected surgically and diagnosed as pulmonary adenocarcinomas by histopathologic examination. Hypoglycemia was temporarily improved after the resection, but a hypoglycemic event occurred 2 months after the surgery. Immunohistochemistry of the tumor demonstrated the expression of insulin-like growth factor 2 in tumor cells. Western blot analysis revealed the expression of high-molecular-weight (big)–insulin-like growth factor 2 in the tumor region. Insulin-like growth factor 2 mRNA expression was also confirmed in the tumor using reverse transcription–polymerase chain reaction. These findings indicate the diagnosis of non–islet cell tumor-induced hypoglycemia caused by big-insulin-like growth factor 2 produced by the tumor in the dog. This report provides information on differentiating tumors that cause paraneoplastic hypoglycemia.

Consecutive hypoglycemia attacks induced by co-trimoxazole followed by pentamidine in a patient with acquired immunodeficiency syndrome

Both co-trimoxazole and pentamidine are used for the treatment of pneumocystis pneumonia (PCP) and are known to cause hypoglycemia as an adverse drug reaction. Here, we describe a rare case of a late-diagnosed female patient with acquired immunodeficiency syndrome (AIDS) who developed the first hypoglycemic attack as an adverse effect of co-trimoxazole, followed by a second hypoglycemic attack as an adverse effect of pentamidine. Physicians caring for patients with AIDS and PCP should be aware of possible hypoglycemia in patients with many risk factors.

Hiperinsulinismo endógeno diagnosticado como epilepsia

El insulinoma es la neoplasia endocrina más común del páncreas, 90% de ellos son benignos, su incidencia es de 4 por 1 millón de personas al año y representa el 1% al 2% de todas las neoplasias pancreáticas. Los insulinomas son la causa más común de hipoglucemia relacionada con hiperinsulinismo endógeno. La naturaleza episódica del ataque hipoglucémico se debe a la secreción intermitente de insulina por el tumor. En adultos, la confirmación biológica y bioquímica de la patología al igual que la búsqueda de su localización se debe realizar luego de la resolución de los episodios de hipoglucemia.El diagnóstico de insulinoma puede ser un reto, patologías psiquiátricas o neurológicas son diagnosticadas de manera errónea antes de llegar a la identificación del tumor en células de los islotes pancreáticos. La resección quirúrgica es la modalidad de tratamiento primario, con la que se resuelve la sintomatología cuando se logra la completa resección del tumor.Abstract The insulinoma is the most common pancreatic endocrine neoplasia, 90% of them are benign, the incidence is 4 per 1 million people a year and accounts for 1% to 2% of all pancreatic neoplasms. Insulinomas are the most common cause of hypoglycemia associated with endogenous hyperinsulinism. The episodic nature of hypoglycemic attack is due to the intermittent insulin secretion by the tumor. In adults, biological and biochemical confirmation of pathology like finding your location should be performed after resolution of hypoglycemic episodes. The diagnosis of insulinoma can be challenging, psychiatric or neurological disorders are diagnosed incorrectly before reaching identifying tumor cells of pancreatic islets. Surgical resection is the primary treatment modality with which the symptoms resolved when complete resection of the tumor is achieved.

Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach

Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%–60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient's autonomy, family expectations, and the current methods for treating the patient's physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.