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The first case of hypoglycemia caused by adenocarcinoma of the gallbladder is reported. An 82 year-old woman was admitted in July 1980, with a history of recurrent hypoglycemic attacks for one year.<BR>The blood glucose levels and plasma insulin levels during the hypoglycemia were less than 40 mg/d<I>l</I> and less than 5 μU/m<I>l</I>, respectively. The insulin responses during the tolbutamide test etc. were very low. Serum human growth hormone responsed little to glucagon-propranolol load, but responsed well to reattack of hypoglycemia. No other endocrine insufficiencies were recognized. Insulinlike activity as estimated by <SUP>14</SUP>C-glucose oxidation using epididymal fat pad was 1, 050 μU/m<I>l</I> (normal control serum level, less tlan 57 μU/m<I>l</I>). Liver scintigraphy revealed a small defect, which was recognized as a small hypervascular nodule at the distal portion of the cystic artery branches by celiac angiography. At operation, the tumor was located on the base of the gallbladder with two small metastatic nodules in the normal liver. A specimen of this tumor revealed well-differentiated adenocarcinoma of the bile duct type with abundant fibrotic stroma. The electron microscopic findings showed secretory granules in the tumor cells. The hypoglycemic attacks subsided completely after removal of the tumor. The amount of resected tumor was estimated to be about 150 g, and was too small to consume the 200 g/day of glucose which was needed to prevent hypoglycemia of this patient.<BR>All these findings support the view that this patient's hypoglycemia was caused by insulinlike activity originating from the adenocarcinoma of the gallbladder.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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