複選題
80.下列何者與低血糖症有關?
(A)lymphoma
(B)insulinoma
(C)pancreas adenocarcinoma
(D)anal sac adenocarcinoma

補充樓上：

A possible cause of refractory hypoglycemia is a non islet cell tumor. In this type of hypoglycemia, tumoral secretion of incompletely processed insulin like growth factor-II (IGF-II), particularly in skeletal muscle, results in stimulation of insulin receptors and increases glucose utilization [5]. Other potential mechanisms include auto antibodies against insulin or insulin receptor and destruction of the liver or adrenal glands because of tumor burden. This type of hypoglycemia occurs in patients with fibromas, mesenchymal tumors, hepatocellular and colorectal carcinomas, myelomas and lymphomas [6,7].

簡單來說，lymphoma導致低血糖另一個可能的機制是因為免疫系統產生自體抗體攻擊胰島素或胰島素receptor，和破壞了肝臟或腎上腺。

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另外，pancreas adenocarcinoma 跟糖尿病相關，機制包含代謝、hormones、免疫等機制，大部分胰臟癌的病患的臨床表現為高血糖：

想了解機制可以參考這篇：


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238796/

另外，2021有一篇研究也提到高血糖作為胰臟癌的risk factor: 

https://www.sciencedirect.com/science/article/pii/S1424390321001599

哈哈，不過我也找到一篇pancreas adenocarcinoma導致低血糖的case study：

不過報告提到“Non-islet tumor induced hypoglycemia has been described in association with various malignancies although its occurrence with pancreatic adenocarcinoma is very rare.” 

pancreas adenocarcinoma導致低血糖是非常罕見的啦！不過不是完全不可能。

https://www.ijcrioncology.com/archive/2017-archive/2017-articles-archive/100043Z10SJ2017-dibya/100043Z10SJ2017-dibya-full-text.php

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