Pure Seminoma with Associated Hypoglycemia

1Carilion Clinic, Roanoke, VA
2Carilion Clinic, Roanoke, VA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 224

Case Presentation:

A 39‐year‐old male with a PMH significant for infantile seizures and a 3‐year history of bilateral lower‐extremity edema presented with a 1‐day history of seizures. Patient noted a 1‐week history of right‐sided scrotal swelling without associated pain to palpation, trauma, or hematuria and a 70‐pound weight loss within The last year. His blood pressure was 171/113 mm Hg, pulse 96/min, respirations 18/min, and oxygen saturation 97% on room air. Physical exam was notable for bilateral 2+ lower‐extremity edema; firm, nontender right lower quadrant mass; and right‐sided nontender scrotal edema. The cardiac and pulmonary exams were unremarkable. Significant lab results included blood glucose 35 mg/dL, serum HCG3l0,Afp1.0 ng/dL, LDH 1852 IU/L, TSH 0.628 ulU/mL, Baseline Cortisol 27, Alkaline phosphatase 157 IU/L,AST 55 IU/L, ALT 12 IU/L, Total Bilirubin 1.4 MG/DL, PT/INR 12/1.1 and IGF‐I 94‐ ng/mL. Hypoglycemia was refractory to treatment with D10 normal saline over the first 24 hours. CT of the abdomen and pelvis with contrast noted an extremely large retroperitoneal mass measuring approximately 21.6 cm in cranial caudal dimension, 2.5 cm in transverse dimension, and 16.6 cm in AP dimension. The right testicle was heterogeneous and markedly enlarged, measuring 8.3 x 5.9 x 7.4 cm with an associated large hydrocele. Chemotherapy was initiated with etoposide, cysplatin, and bleomycin, and radical orchiectomy was performed. The abdominal mass showed dramatic regression in response to chemotherapy and patients' hypoglycemia resolved.

Discussion:

NICTH is a rare phenomenon first described in 1929 in a case of hepatocellular carcinoma, and since, described in association with many tumor types and with large tumor burden. Although this case involves a large tumor, no literature has yet described NICTH associated with a pure seminoma. The hypoglycemia associated with NICTH is thought be secondary to oversecrelion of ihe pro‐IGF‐ll and is up to 4 times less common than insulinoma. Patients with suspected NICTH have experienced suppressed insulin, C‐peptide, and GH, which subsequently decrease serum IGF‐I. IGF‐II serum levels are normal in patients with NICTH; however, pro‐IGF‐ll levels are elevated. Detection techniques are available thai could delineate pro‐IGF‐ll as a possible tumor marker in NICTH.

Conclusions:

Non‐islet cell tumor‐induced hypoglycemia (NICTH) is a rare phenomenon, caused by the production of insulin growth factor II (IGF‐II) and most often occurring secondary to large tumors of mesenchymal origin. Here, we present a case of hypoglycemia associated with a pure seminoma, which has not previously been described in the literature.

Author Disclosure:

R. Brevetta, none; C. DeMott, none.

To cite this abstract:

Brevetta R, DeMott C. Pure Seminoma with Associated Hypoglycemia. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 224. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/pure-seminoma-with-associated-hypoglycemia/. Accessed July 22, 2019.

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