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      Hypoglycemia due to Ectopic Release of Insulin from a Paraganglioma

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          Insulin-secreting pancreatic tumors and insulin-like growth hormone-secreting non-islet cell tumors can cause hypoglycemia. However, insulin-releasing paraganglioma or pheochromocytoma has almost never been reported. A 67-year-old female patient was admitted to our hospital because of headache, palpitation, perspiration, faintness, frequent sense of hunger and absent-mindedness. These intermittent symptoms had begun approximately a year before admission. On physical examination, she had high blood pressure of 150/90 mm Hg. Hormonal studies demonstrated increased urinary norepinephrine levels, and hyperinsulinemic hypoglycemia was confirmed while the patient was symptomatic. Abdominal MRI revealed a retroperitoneal mass measuring 4.5 cm in the pancreatic region. She was treated with an alpha-blocking agent to control blood pressure preceding the removal of the mass. Histopathological diagnosis was paraganglioma, and immunohistochemically insulin staining in the neoplastic cells was demonstrated. Her blood pressure normalized and hypoglycemia relieved after the operation. The patient did not have recurrence of hypoglycemia after a year of follow-up. Paraganglioma is a rare tumor of the neural crest, and co-secretion of insulin and catecholamines has been reported only by a single case report in the literature. The present patient is another case with this co-secretion.

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          Most cited references 17

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          Hypoglycemic disorders.

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            [ACTH-producing paraganglioma of the paranasal sinuses].

            Paragangliomas are tumours of neuroectodermal origin and hormonally active in rare instances. They are very unusual in the paranasal sinuses. We report on the first case--as far as we know--of a recurrent nasal paraganglioma, which started to produce ACTH after a period of ten years and resulted in Cushing's syndrome. Resection of the tumour normalised ACTH and cortisol secretion.
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              Hypoglycemia due to an insulin-secreting small-cell carcinoma of the cervix.


                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                May 2007
                05 February 2007
                : 67
                : 6
                : 292-295
                aDivision of Endocrinology and Metabolism, Department of Internal Medicine, and bDepartment of Pathology, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
                99291 Horm Res 2007;67:292–295
                © 2007 S. Karger AG, Basel

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                Figures: 2, References: 25, Pages: 4
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