PMID- 15811488
OWN - NLM
STAT- MEDLINE
DCOM- 20050720
LR  - 20220419
IS  - 0149-2918 (Print)
IS  - 0149-2918 (Linking)
VI  - 27
IP  - 2
DP  - 2005 Feb
TI  - Treatment of hypoglycemia using combined glucocorticoid and recombinant human 
      growth hormone in a patient with a metastatic non-islet cell tumor hypoglycemia.
PG  - 246-51
AB  - BACKGROUND: Non-islet cell tumor hypoglycemia(NICTH) is a rare cause of recurrent 
      hypoglycemia. It has been associated with the tumoral overproduction of 
      high-molecular-weight insulin-like growth factor (IGF)-2 ("big IGF-2"). Big IGF-2 
      suppresses growth hormone (GH) biosynthesis and impairs the storage of IGFs by 
      suppressing the formation of the GH-dependent ternary complexes containing IGF, 
      IGF binding protein 3 (IGFBP-3), and acid-labile subunit (ALS). Thus, big IGF-2 
      exerts hypoglycemic activity. The only effective treatment of NICTH is surgery. 
      However, in inoperable patients with NICTH, treatment of hypoglycemia may require 
      high doses of glucocorticoid (30-60 mg/d [0.5-1.0 mg/kg x d]) or recombinant 
      human GH (rhGH) (2.6-12.0 mg/d [0.043-0.20 mg/kg x d]). OBJECTIVE: We 
      hypothesized that the association of low doses of glucocorticoid and rhGH could 
      be an effective therapy for hypoglycemia in inoperable patients with NICTH. 
      METHODS: A 3-phase treatment regimen was conducted in an inoperable 67-year-old 
      woman with NICTH. Decreasing dosages of prednisone (from 30 to 10 mg/d [from 0.50 
      to 0.15 mg/kg x d]), followed by decreasing doses of rhGH (from 2.6 to 1.3 mg/d 
      [from 0.043 to 0.016 mg/kg x d]), and then a combination of the lowest doses of 
      each, were tested. Glucose, insulin, and IGF monitoring were performed at each of 
      the 3 treatment phases. RESULTS: Fasting plasma glucose (FPG) level was 
      normalized and the IGF-1 concentration was increased with high-dose prednisone 
      monotherapy (30 mg/d [0.50 mg/kg x d]) or rhGH (2.6 mg/d [0.043 mg/kg x d]). 
      Prednisone monotherapy partially suppressed big IGF-2 secretion, and rhGH 
      monotherapy acted on IGFBP-3 and ALS concentrations. FPG level was normalized 
      with combined low-dose prednisone and rhGH, and this combination was more 
      effective than high-dose monotherapy with either drug in reestablishing the IGF 
      system. No adverse effects (AEs) were found. CONCLUSIONS: In this patient with 
      inoperable NICTH, the combination of low doses of prednisone and rhGH was a 
      successful long-term therapy for hypoglycemia, with no AEs. This therapy could be 
      proposed for use in patients with inoperable NICTH.
FAU - Bourcigaux, Nathalie
AU  - Bourcigaux N
AD  - Endocrinology and Metabolism Service, Center University Hospital, Nantes, France. 
      nathalie.bourcigaux@sat.aphop-paris.fr
FAU - Arnault-Ouary, Gwenaelle
AU  - Arnault-Ouary G
FAU - Christol, Remy
AU  - Christol R
FAU - Perin, Laurence
AU  - Perin L
FAU - Charbonnel, Bernard
AU  - Charbonnel B
FAU - Le Bouc, Yves
AU  - Le Bouc Y
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Blood Glucose)
RN  - 0 (Glucocorticoids)
RN  - 0 (Insulin)
RN  - 0 (Insulin-Like Growth Factor Binding Protein 3)
RN  - 0 (Recombinant Proteins)
RN  - 12629-01-5 (Human Growth Hormone)
RN  - 67763-96-6 (Insulin-Like Growth Factor I)
RN  - VB0R961HZT (Prednisone)
SB  - IM
MH  - Aged
MH  - Blood Glucose/drug effects
MH  - Drug Therapy, Combination
MH  - Female
MH  - Fibroma/pathology
MH  - Glucocorticoids/administration & dosage/*therapeutic use
MH  - Human Growth Hormone/administration & dosage/*therapeutic use
MH  - Humans
MH  - Hypoglycemia/*drug therapy/etiology
MH  - Insulin/blood
MH  - Insulin-Like Growth Factor Binding Protein 3/metabolism
MH  - Insulin-Like Growth Factor I/metabolism
MH  - Liver Neoplasms/*complications/secondary
MH  - Pleural Neoplasms/pathology
MH  - Prednisone/administration & dosage/*therapeutic use
MH  - Recombinant Proteins/administration & dosage/therapeutic use
EDAT- 2005/04/07 09:00
MHDA- 2005/07/21 09:00
CRDT- 2005/04/07 09:00
PHST- 2004/11/10 00:00 [accepted]
PHST- 2005/04/07 09:00 [pubmed]
PHST- 2005/07/21 09:00 [medline]
PHST- 2005/04/07 09:00 [entrez]
AID - S0149-2918(05)00023-8 [pii]
AID - 10.1016/j.clinthera.2005.02.004 [doi]
PST - ppublish
SO  - Clin Ther. 2005 Feb;27(2):246-51. doi: 10.1016/j.clinthera.2005.02.004.