Severe paraneoplastic hypoglycemia secondary to a gastrointestinal stromal tumour masquerading as a stroke

Endocrinology, Diabetes & Metabolism Case Reports

article

G K Dimitriadis¹  K Gopalakrishnan⁴  R Rao¹  D K Grammatopoulos¹  H S Randeva³  M O Weickert¹  N Murthy¹ 

[1] Warwick Institute for the Study of Endocrinology, Diabetes and Metabolism ,(WISDEM Centre), The Arden NET Centre, University Hospitals of Coventry and Warwickshire;Division of Experimental Medicine, Faculty of Medicine, Imperial College London, Hammersmith Campus;Division of Translational and Systems Medicine, Warwick Medical School, University of Warwick;Departments of Histopathology;Departments of Clinical Biochemistry

关键词: Geriatric;    Female;    White;    United Kingdom;    Duodenum;    Stomach;    Endocrine-related cancer;    IGF2;    Insulin;    Hypoglycaemia;    Non-islet-cell tumour hypoglycaemia;    Gastrointestinal stromal tumour;    Hypoglycaemia;    Headache;    Paraesthesia;    Ptosis;    Pelvic mass;    Hemiparesisy;    Facial palsy;    Hepatomegaly;    Myasthaenia;    CT scan;    Immunohistochemistry;    Glucose (blood);    Biopsy;    Ultrasound-guided biopsy;    IGF 2;    Insulin;    C-peptide (blood);    Imatinib;    Tyrosine-kinase inhibitors;    Glucagon;    GH;    Prednisolone;    Glucocorticoids;    Glucose;    Gastroenterology;    Unique/unexpected symptoms or presentations of a disease;    October;    2015;   

DOI  :  10.1530/EDM-15-0062

学科分类：血液学

来源: Bioscientifica Ltd.

【 摘 要 】

We report the case of a 70-year-old previously healthy female who presented acutely to the Accident and Emergencydepartment with left-sided vasomotor symptoms including reduced muscle tone, weakness upon walking and slurredspeech. Physical examination confirmed hemiparesis with VIIth nerve palsy and profound hepatomegaly. A random glucosewas low at 1.7 mmol/l, which upon correction resolved her symptoms. In hindsight, the patient recalled having had similarepisodes periodically over the past 3 months to which she did not give much attention. While hospitalized, she continuedhaving episodes of symptomatic hypoglycaemia during most nights, requiring treatment with i.v. dextrose and/or glucagon.Blood tests including insulin and C-peptide were invariably suppressed, in correlation with low glucose. A Synacthenstimulation test was normal (Cort (00) 390 nmol/l, Cort (300) 773 nmol/l). A computed tomography scan showed multiplelobulated masses in the abdomen, liver and pelvis. An ultrasound guided biopsy of one of the pelvic masses was performed.Immunohistochemistry supported the diagnosis of a gastrointestinal stromal tumour (GIST) positive for CD34 and CD117.A diagnosis of a non islet cell tumour hypoglycaemia (NICTH) secondary to an IGF2 secreting GIST was confirmed with furtherbiochemical investigations (IGF2Z96.5 nmol/l; IGF2:IGF1 ratio 18.9, ULN !10). Treatment with growth hormone resolvedthe patient’s hypoglycaemic symptoms and subsequent targeted therapy with Imatinib was successful in controlling diseaseprogression over an 8-year observation period.

【 授权许可】

CC BY-NC-ND