c-peptide and Stomach-Neoplasms

Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome that secretes incompletely processed high molecular weight insulin growth factor 2 (big-IGF2), which results in stimulation of the insulin receptor and subsequently induces hypoglycemia. Gastrointestinal stromal tumor (GIST) is a common intestinal mesenchymal neoplasm of the gastrointestinal tract. The most frequent site of GIST is the stomach; NICTH induced by IGF2-producing stomach GISTs is rare.. An 84-year-old man was admitted to the hospital due to impaired consciousness (JCS II-10) in the morning. At the time of admission, his serum glucose was 44 mg/dL; his consciousness was restored with 20 ml of 50% glucose. To avoid hypoglycemia, a continuous intravenous infusion of glucose as well as dietary intervention was required. At the time of hypoglycemia, the levels of insulin and C-peptide were suppressed. Additionally, IGF1 levels were below the normal range. Abdominal computed tomography revealed that he had a large lobulated mass (116 × 70 × 72 mm) around the gastric corpus. Pathological analysis of biopsy specimens identified disarray of spindle cells and positivity for c-kit as well as strong positivity for DOG-1. Further analysis revealed high levels of Ki-67 (Mib-1 index: 15.5%) and mitotic index (7/50HPF); the tumor was diagnosed as high-risk GIST, and complete surgical resection was performed. Hypoglycemia resolved immediately after tumor resection. The resected tumor specimen was positive for IGF2 staining, and big-IGF2 (11-18 kDa) was detected in preoperative serum and tumor samples; the patient was diagnosed with NICTH due to an IGF2-producing tumor.. NICTH is rare in GIST of the stomach; however, the large GIST could produce big-IGF2 and subsequently cause severe hypoglycemia, requiring prompt evaluation and complete tumor resection.

Topics: Aged, 80 and over; C-Peptide; Gastrointestinal Stromal Tumors; Humans; Hypoglycemia; Insulin; Insulin-Like Growth Factor I; Insulin-Like Growth Factor II; Male; Paraneoplastic Syndromes; Stomach Neoplasms; Tomography, X-Ray Computed

To date, the association between diabetes mellitus (DM) and gastric cancer has been controversial, including the underlying mechanism. We investigated the association between plasma diabetic biomarkers (insulin, C-peptide, and blood glucose) and gastric cancer risk. In addition, homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were calculated. A total of 36,745 subjects aged 40-69 years in the Japan Public Health Center-based prospective study (JPHC) who returned the baseline questionnaire and provided blood samples were followed from 1990 to 2004. In the present analysis, 477 cases and 477 matched controls were used. The odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) for developing gastric cancer were calculated using conditional logistic regression models. Plasma insulin was positively associated with increased risk of gastric cancer; compared to tertile 1, ORs were 1.69 (95% CI = 1.11-2.59) and 2.01 (1.19-3.38) for tertiles 2 and 3, respectively (p for trend = 0.009). In men, C-peptide was also positively associated with a significant risk; corresponding ORs were 1.42 (0.85-2.38) and 1.91 (1.03-3.54), respectively (p for trend = 0.04). These findings were confirmed for blood samples from the fasting group (≥8 hr after a meal). Higher HOMA-IR was also associated with increased risk, whereas no association was observed for blood glucose. Our findings suggest that Japanese population with higher insulin and C-peptide levels derived from insulin resistance have an elevated risk of gastric cancer.

Topics: Adult; Aged; Alcohol Drinking; Blood Glucose; C-Peptide; Female; Humans; Insulin; Insulin Resistance; Male; Middle Aged; Prospective Studies; Public Health; Risk; Stomach Neoplasms

Adiponectin is a peptide hormone secreted from the adipose tissue, affecting the proliferation and insulin sensitivity in different cell types. The levels of adiponectin have been found to be decreased in hyperinsulinemia and insulin resistant states, such as obesity. The previous studies have suggested that plasma adiponectin levels are decreased in patients with endometrial and breast cancer. In our study, the relationship among serum adiponectin levels, demographic features and histopathological variables was evaluated in gastric cancer patients. Forty consecutive patients with gastric cancer who underwent gastrectomy with standard lymph node dissection were included and 43 healthy controls were included in this study. The serum levels of glucose, insulin, C-peptide, HbA1c and adiponectin were measured in both groups. We analyzed the correlation among these parameters and patients' demographic features, such as age, gender, body mass index (BMI) and histopathological variables such as tumor localization, stage, nodal status, histological grade, vascular and lymphatic invasion. The mean age was 60.05+9.72 in patients, while it was 38.6+12.73 in controls. The mean serum adiponectin levels were 12.62+7.9 and 10.07+6.72 ng/ml, respectively, in groups. There was no different in terms of adiponectin, C-peptide, HOMA-R level in both groups. On the other hand, BMI, glucose and insulin levels were significantly different in gastric cancer patients in comparison with the controls. There was no correlation among the levels of adiponectin, BMI, insulin and c-peptide levels in patient group (P>0.05). The adiponectin levels of woman were significantly lower than male patients (P=0.002). No relations were detected among tumor stage, tumor localization, nodal status, lymphatic and vascular invasion, and the levels of serum adiponectin (P>0.05). Interestingly, a positive correlation was found between tumor grade and plasma adiponectin levels (r=0.372; P=0.018). Our results suggest that plasma adiponectin levels were similar in both patients with gastric cancer and the controls. In addition, no correlation was found between adiponectin levels and demographic features and histopathological variables of patients. But, in undifferentiated tumors, plasma adiponectin level was significantly higher than well-differentiated grade tumors.

Topics: Adiponectin; Adult; Aged; Blood Glucose; Body Mass Index; C-Peptide; Case-Control Studies; Female; Gastrectomy; Gastric Mucosa; Humans; Insulin; Insulin Resistance; Lymph Node Excision; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Obesity; Prognosis; Risk Factors; Stomach Neoplasms; Survival Rate

Adipocytokines are adipocyte-secreted hormones associated with some malignancies. We investigated the association of adipocytokines with gastric cancer.. The levels of body mass index (BMI) and adiponectin, leptin, resistin, visfatin, and C-peptide in blood at diagnosis were measured in 156 gastric cancer patients and 156 age- and sex-matched controls. Logistic regression models were used to estimate odds ratio, and one-way analysis of variance was performed to examine the prevalence of each variable between 2 or more groups.. Adiponectin, C-peptide and BMI levels were significantly lower, and resistin and visfatin levels were significantly higher in the patients on multivariate analysis (P=0.0004, 0.0006, 0.0051, 0.0006 and 0.0013, respectively). In the controls, the inverse correlation between BMI and adiponectin was comparatively strong, but was weak in the patients. The correlation between BMI and leptin was strong in both the controls and the patients. The correlation between BMI and resistin or visfatin was not clear in either the patients or the controls. The correlation between BMI and C-peptide was not clear in the controls, but might be weak in the patients. Leptin, C-peptide and BMI levels gradually decreased with stage progression, and resistin and visfatin levels gradually increased with stage progression (P<0.0001 for all). Comparison between 38 patients with Stage I gastric cancer and the controls showed that adiponectin level tended to decrease in the patients (P=0.0582), and BMI level was not different between two groups (P=0.2480).. Resistin and visfatin may be good biomarkers of gastric cancer.

Topics: Adipokines; Aged; Biomarkers; Body Mass Index; C-Peptide; Cachexia; Case-Control Studies; Female; Humans; Male; Middle Aged; Nicotinamide Phosphoribosyltransferase; Resistin; Stomach Neoplasms

The effect of vagotomy and gastric resection on insulin secretion was examined by the glucagon stimulated C-peptide test in gastrectomy patients (n = 11) without truncal vagotomy and in total gastrectomy patients (n = 10) with truncal vagotomy. The test was performed twice in each patient: 10 minutes after the midline incision was made and then 60 to 90 minutes later when gastric resection or total gastrectomy was completed, during the reconstructive phase of the operation. Gastric resection without truncal vagotomy was followed by a higher increase (48%) in serum C-peptide concentration caused by glucagon stimulation than total gastrectomy with truncal vagotomy (13%). There was a significant (p less than 0.05) increase in the glucagon stimulated glucose-related C-peptide concentration in patients without truncal vagotomy, whereas truncal vagotomy inhibited this increase. These results suggest that truncal vagotomy will produce a reduction in stimulated insulin secretion in humans.

Topics: Adult; Aged; Blood Glucose; C-Peptide; Female; Gastrectomy; Glucagon; Humans; Insulin; Insulin Secretion; Intraoperative Period; Male; Middle Aged; Pancreas; Secretory Rate; Stomach Neoplasms; Stomach Ulcer; Time Factors; Vagotomy, Truncal

Artificial hyperglycemia (AHG) used in the cancer treatment considerably increases the insulin and S-peptide content in blood, decreases the glucagon concentration and tissue glucose tolerance. The changes are reversible, have a functional character, that indicates the absence of a disbalance in hormonal mechanisms of carbohydrate metabolism control as well as marked disorders of the pancreas function. In order to achieve a wider range of indications for using AHG in complex schemes of the cancer treatment, it is necessary to take measures on optimization of the carbohydrate metabolism state which should be controlled by the suggested complex of laboratory tests.

Topics: Antineoplastic Agents; Blood Glucose; C-Peptide; Carbohydrate Metabolism; Combined Modality Therapy; Glucagon; Glucose Tolerance Test; Humans; Insulin; Insulin Secretion; Lung Neoplasms; Stomach Neoplasms

Insulin and C-peptide levels were studied with a radioimmunoassay in the peripheral blood serum of 44 patients with gastric and cervical cancer and 22 healthy persons. Hyperfunction of the pancreatic insular apparatus was shown in cancer patients which was expressed in a statistically significant increase in the C-peptide level. In gastric cancer patients hyperfunction of the insular apparatus was accompanied by hypoinsulinemia, and in cervical cancer patients by hormoinsulinemia. However an analysis has shown that the ratio insulin/C-peptide in gastric and cervical cancer patients was about the same and significantly lower than the control. A conclusion has been made that in spite of difference in the initial insulin concentration, the same phenomenon--acceleration of the metabolic clearance of insulin--occurs in patients with cancer of the above sites. As a result of treatment irrespective of its modality the reverse development of changes revealed before treatment took place. The C-peptide level decreased, the ratio insulin/C-peptide increased, i.e. hyperfunction of the insular apparatus disappeared and the metabolic clearance of insulin slowed down.

Topics: C-Peptide; Female; Humans; Insulin; Peptides; Stomach Neoplasms; Uterine Cervical Neoplasms