向编辑:
We read with interest the article by Metintaset al.1论非血糖病变及其与石棉暴露的关联。值得注意的是,另一种形式的胸腔肿瘤,孤零性纤维肿瘤,仍然是一个不同的实体,有趣地没有与石棉暴露有关2,3. Asbestos usually causes more diffuse forms of pleural lesions4. Solitary fibrous tumours are rare tumours with a 12–13% rate of malignancy.
We recall an interesting case of a 93-yr-old male, who was a resident at a home for the elderly, with a history of pulmonary tuberculosis and exposure to asbestos. He presented to us with recurrent episodes of decreased consciousness, particularly in the morning. Glucose concentrations of between 1.8–2.5 mmol·L−1在攻击期间被记录。他没有姿势低血压,血液数正常,肝脏,骨,甲状腺和肾功能曲线。此外,他的生长激素和胰岛素样生长因子(IGF)-I水平和短突发试验也是不起眼的。胸部射线照片揭示了一个巨大的哑铃形状钙化质量占据整个左半旋转(图1A⇓)。计算断层扫描(图1B⇓) showed features consistent with a large solitary fibrous tumour, which was confirmed by fine-needle aspiration. Insulin and c-peptide levels were measured to exclude insulinoma, and the uncommon diagnosis of Doege-Potter syndrome was made.
![Fig. 1—](http://www.qdcxjkg.com/content/erj/27/3/655/F1.medium.gif)
a) Chest radiograph of solitary fibrous tumour occupying almost the entire left hemithorax. b) Computed tomography scan with three-dimensional reconstruction of the large left pleural tumour.
In 1930, K.W. Doege and R.P. Potter, who was a radiologist, first reported the association between intrathoracic fibrous tumour and hypoglycaemia. The syndrome of hypoglycaemia is seen in <5% of cases of solitary fibrous tumours, and is usually associated with tumours that are large with a high mitotic rate. The postulated mechanisms include tumour-induced augmented glucose utilisation and tumour IGF II production. Surgical resection of the tumour is usually curative5, however, our patient declined surgery. Other less invasive forms of therapy, such as radiofrequency ablation and arterial embolisation of the tumour, were also declined. The patient opted for conservative treatment by intravenous dextrose.
临床医生应该意识到这种罕见的,但重要的经常性低血糖的原因,并在评估患者的评估中排除胸腔肿瘤。
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