Paraneoplastic hypoglycaemia secondary to IGF-2 secretion from a metastatic gastrointestinal stromal tumour

Endocrine and Metabolic Science

Harpal S. Randeva¹  Georgios K. Dimitriadis²  Eftychia E. Drakou³  Michael C. Onyema⁴  Christos Kosmas⁵  Narasimha Murthy⁶  Bianca M. Leca⁶  Georgios Giovos⁶  Ashley B. Grossman⁷  Ratnadeep Ganguly⁸ 

[1] Barts and the London School of Medicine, Centre for Endocrinology, William Harvey Institute, London, EC1M 6BQ, UK;Neuroendocrine Tumour Unit, Royal Free Hospital, London NW3 2QG;Department of Clinical Oncology, Guy's Cancer Centre - Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK;Department of Endocrinology and Metabolism, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK;Hematopoietic Cell Transplant Unit, Division of Medical Oncology, Department of Medicine, ''Metaxa'' Cancer Hospital, Piraeus, Greece;Human Metabolism Research Unit, WISDEM Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK;Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LE, UK;Pathology Labs, UHCW NHS Trust, Coventry, CV2 2DX, UK;

关键词: Paraneoplastic;    Hypoglycaemia;    Non-islet cell tumour;    GIST;    Imatinib;    IGF-2;   

DOI  :  

来源: DOAJ

【 摘 要 】

We report the case of a 79-year-old male with previous history of non-Hodgkin's lymphoma in remission, who presented acutely to the Accident and Emergency department with recurrent episodes of hypoglycaemia. At the time of presentation, a random glucose was low at 1.4 mmol/l, which upon correction resolved his symptoms. In hindsight, the patient recalled having had similar episodes periodically over the past 2 months to which he did not give much notice. While hospitalized, he continued having episodes of symptomatic hypoglycaemia, requiring treatment with intravenous dextrose and per os steroids. Once stable, he was discharged on oral prednisolone and dietary advice. A computed tomography scan performed during inpatient stay showed multiple deposits in the abdomen. An ultrasound guided biopsy of one of the liver deposits was performed. Immunohistochemistry supported the diagnosis of a gastrointestinal stromal tumour (GIST) positive for CD34 and CD117. The diagnosis of non-islet cell tumour hypoglycaemia (NICTH) secondary to an IGF2 secreting GIST was confirmed with further biochemical investigations (IGF2=105.9 nmol/l; IGF2:IGF1 ratio 23, Upper Level of Normal (ULN) <10). Targeted cytoreductive treatment with Imatinib mesylate following assessment of the tumour's mutational status was successful in preventing hypoglycaemia over a 21-month follow-up observation period.

【 授权许可】

Unknown