NICTH in Malignant Mesothelioma: Case Report
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Non-islet Cell Tumour Hypoglycaemia (NICTH) in Malignant Mesothelioma: Case Report
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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WAI KEAT Wong
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Non-islet Cell Tumour Hypoglycaemia (NICTH) in Malignant Mesothelioma: Case Report
Year: 2015
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Non-islet cell tumor hypoglycemia (NICTH) is a rare but clinically significant condition often associated with malignant neoplasms, including mesothelioma. This case report outlines the clinical journey of a 56-year-old non-diabetic woman diagnosed with unresectable malignant pleural mesothelioma. The patient presented with recurrent episodes of unexplained hypoglycemia, and after ruling out surreptitious insulin use or other hypoglycemic agents, further investigations confirmed the diagnosis of NICTH through hormonal analysis.
Pathophysiology of NICTH
The underlying mechanism of NICTH involves an abnormal increase in "big"-insulin-like growth factor-II, a form of IGF-II produced by certain tumors, which contributes to hypoglycemia. In this patient, serum insulin levels were low, and while insulin-like growth factor-I (IGF-I) levels were markedly suppressed, IGF-II levels remained normal, with significantly elevated levels of "big"-IGF-II. The suppression of growth hormone (GH) was also noted, which is commonly observed in cases of NICTH due to the feedback mechanisms involving IGF levels. As the disease progressed, conventional treatments such as prednisone and diazoxide were ineffective, necessitating the adoption of a combination of dexamethasone and recombinant human growth hormone to effectively manage her hypoglycemic episodes.
Conclusion
This case exemplifies the challenges of managing NICTH in patients with advanced malignant mesothelioma. The combination therapy of dexamethasone and recombinant human growth hormone proved successful in alleviating hypoglycemia, although the patient ultimately succumbed to complications related to her cancer shortly thereafter. This highlights the importance of recognizing NICTH as a potential complication in patients with malignancies and reflects the necessity for individualized treatment strategies, including hormonal therapies that target the unique mechanisms of hypoglycemia in such cases. Further research into the pathophysiology and therapeutic approaches for NICTH is warranted to enhance patient care in similar clinical scenarios.
FAQ section (important questions/answers):
What is non-islet cell tumor hypoglycemia (NICTH)?
NICTH is a rare but significant condition characterized by recurrent hypoglycemia caused by certain tumors, particularly those of non-islet cell origins, such as malignant mesothelioma. It results from the abnormal production of insulin-like growth factor II, leading to low blood sugar levels.
How was NICTH diagnosed in the reported case?
In the case of a 56-year-old woman with malignant pleural mesothelioma, NICTH was diagnosed through low levels of insulin and insulin-like growth factor I, alongside elevated levels of 'big'-IGF-II. This diagnosis was confirmed after ruling out surreptitious insulin use.
What treatments were applied to manage NICTH in this patient?
Initial treatments with prednisone and diazoxide were ineffective in controlling hypoglycemia. However, a combination of dexamethasone and recombinant human growth hormone successfully alleviated the hypoglycemic episodes, improving the patient's condition.
What role do insulin-like growth factors play in NICTH?
In NICTH, abnormal production of immature forms of insulin-like growth factor II, particularly 'big'-IGF-II, contributes to hypoglycemia by mimicking insulin's effects. This leads to low blood sugar levels despite suppressed insulin production.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “NICTH in Malignant Mesothelioma: Case Report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
The term 'Table' refers to a structured format, often used to present data or findings in an organized manner. In the context of medical literature, tables summarize important information, such as treatment responses or patient demographics, making it easier for readers to understand and analyze the results of a study.
2) Blood:
The keyword 'Blood' is critical in medical contexts as it is essential for life. It transports oxygen, nutrients, and hormones, and plays a crucial role in immune defense and waste removal. In the mentioned case, measuring blood glucose levels was pivotal in diagnosing hypoglycemia, providing vital information for treatment.
3) Disease:
'Disease' denotes a pathological condition resulting from genetic, environmental, or lifestyle factors. Understanding the disease is crucial for diagnosis and management. In the context provided, non-islet cell tumor hypoglycemia (NICTH) exemplifies the complexity of diseases that emerge from cancers, demonstrating the interactions between tumors and metabolic processes.
4) Medicine:
'Medicine' encompasses the science and practice of diagnosing, treating, and preventing illnesses. It includes various disciplines to address health issues like hypoglycemia. The interdisciplinary approach in the case demonstrates how understanding biochemical processes and treatments contributes to better patient outcomes, particularly in complex conditions like malignant mesothelioma.
5) Cancer:
'Cancer' is a term for a group of diseases characterized by uncontrolled cell growth. In the case study, the patient's hypoglycemia was linked to malignant pleural mesothelioma, illustrating how certain cancers can lead to unique and serious health issues, such as NICTH, affecting the overall treatment and prognosis.
6) Ter:
'Ther' likely stands for 'therapy' or 'treatment,' which signifies the methods employed to manage a disease. In the text, various therapeutic regimens for managing hypoglycemia were described, underlining the importance of tailored treatments in addressing complex clinical conditions, particularly in the presence of malignancies that present unique challenges.
7) Radiotherapy:
'Radiotherapy' is a treatment modality that uses radiation to target and destroy cancer cells. It is commonly employed in cancer management. Although not directly discussed in this case, radiotherapy may be a consideration in treating malignant pleural mesothelioma, showcasing the multidisciplinary approach to cancer care and the various available treatments.
8) Observation:
'Observation' in a medical context refers to the monitoring of a patient's condition and response to treatment. It is vital for determining the effectiveness of therapies. In the provided report, careful observation of blood glucose levels and symptoms guided the selection of appropriate treatments, highlighting its role in clinical decision-making.
9) Discussion:
'Discussion' typically follows a report or study, where findings are analyzed and contextualized. In academic papers, the discussion section evaluates significance, limitations, and implications of findings. The text's discussion on NICTH emphasizes understanding pathophysiology and treatment efficacy, fostering deeper insight into rare clinical manifestations in oncology.
10) Activity:
'Activity' often relates to the functional processes of biological systems. In the medical realm, it can refer to metabolic or physiological functions. In the context given, activity may refer to the biological activity of growth factors influencing blood glucose levels, highlighting the intricacies of biochemical interactions in disease states.
11) Nature:
'Nature' refers to the fundamental characteristics or intrinsic qualities of a subject. In medicine, it describes the underlying mechanisms of diseases or conditions. The text illustrates the nature of non-islet cell tumor hypoglycemia, shedding light on its complexities, which are crucial for understanding and mitigating its clinical impact.
12) Rules:
'Rules' suggest established guidelines or principles in medical practice or research. In the context of medical case reports, following rules or protocols for diagnosis, treatment, and reporting findings is essential. Adhering to these standards ensures consistency, quality, and ethical considerations in clinical research and patient management.
13) Birth:
'Birth' commonly relates to the beginning or emergence of something new. In a medical context, it could pertain to new medical conditions or scientific insights. The text delves into the birth and growth of NICTH as a recognized phenomenon in the medical community, illustrating evolving understanding in oncology.
14) Study (Studying):
'Study' in medicine refers to systematic investigation or research to understand health conditions or treatment outcomes. The mentioned case represents a study of an unusual clinical presentation, contributing valuable data to medical literature. Such studies are fundamental for advancing knowledge and improving treatment strategies for rare conditions.
15) Sweating (Sweat):
'Sweat' is a physiological response of the body, typically indicating temperature regulation or stress. In the provided text, sweat is noted as a symptom of hypoglycemia. Recognizing such signs is critical in clinical settings, as they guide healthcare professionals in diagnosing conditions and providing appropriate interventions.
16) Post:
'Post' can refer to after or subsequent to a particular event. In a medical context, it may relate to post-treatment evaluations or follow-up care. In the case study, post-therapeutic monitoring of blood glucose is essential to assess the effectiveness of treatment and the overall management of the patient's condition.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘NICTH in Malignant Mesothelioma: Case Report’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Vicious cycle, Therapeutic agent, Insulin, Treatment modalities, Case report, Hypoglycaemia, Surgical resection, Combination therapy, Clinical research, Histological examination, Dexamethasone, Chemotherapy and Radiotherapy, Combined treatment, Blood glucose level, Diagnostic imaging, Glycaemic response, Oral Hypoglycaemic Agent, Computed Tomography (CT), Growth Hormone, Binary complexes, Serum level, Insulin-like growth factor-I, Insulin-like growth factor, Human growth hormone, Octreotide, Intravenous infusion, Endocrine Disease, Growth hormone concentration, Neoplasm, Somatostatin analogues, Growing recognition, Insulin antibodies, Hypoglycaemic episodes, Glucose-lowering effects, Hepatic gluconeogenesis, Ternary complex formation, Severe hypoglycaemia, Glucocorticoid, Clinical update, Prednisone, Diazoxide, IGF-I, Oral prednisone, Ternary complex.