Hypoglycemia is a common medical emergency. It is the most frequent complication induced by anti-diabetic treatment. However, it can be observed in other conditions unrelated to diabetes such as
insulinoma, autoimmune disorders, and
neoplasia. Herein, we report the case of a rare cause of severe and recurrent
hypoglycemia in a 77-year-old woman with a malignant
solitary fibrous tumor (MSFT). A 77-year-old woman was admitted to the emergency department for
loss of consciousness induced by severe
hypoglycemia. Her standard laboratory findings were unremarkable. HbA1c,
albumin, renal, liver, thyroid, and adrenal function tests were normal. Cerebral CT scan was also normal. At the time of confirmed
hypoglycemia, the serum level of
insulin and
C-peptide was low. On the basis of the past medical history and the absence of other comment etiologies, a paraneoplastic cause was suspected. Thus, the diagnosis of a non-
islet cell tumor-induced
hypoglycemia (NICTH) was established by the presence of incompletely processed precursors of IGF2 (big IGF2) in plasma electrophoresis. However, the IGF1 level was low.
Therapy with
corticosteroids improved
hypoglycemia and clinical symptoms. NICTH is a rare cause of
hypoglycemia. It should be considered in patients with mesenchymal or
malignant epithelial tumors suffering from recurrent episodes of
hypoglycemia. The diagnosis will be established in the case of low serum
insulin concentrations and elevated levels of big IGF2. Treatment with
corticosteroids, GH, or both can improve
hypoglycemic symptoms and restore plasma
glucose to normal levels.
LEARNING POINTS: NICTH is a very rare condition that should be considered in patients known to have mesenchymal or
malignant epithelial tumors and suffering from recurrent episodes of
hypoglycemia.The diagnosis of an NICTH is established on the basis of the hypoinsulinemic
hypoglycemia, the MSFT history, and the presence of paraneoplastic secretion of IGF1 or an immature form of IGF2.Treatment with
corticosteroids, GH, or both can improve
hypoglycemic symptoms and restore plasma
glucose to normal levels in NICTH.