Non-islet cell tumour hypoglycaemia in a patient with a gastrointestinal stromal tumour

Abstract

Tumour induced hypoglycaemia is a rare paraneo-plastic phenomenon. Insulinomas are the mostcommon tumours associated with hypoglycaemia.The incidence of these insulin secreting tumours isestimated at 0.5 to 4 per million people per year[1,2]. However, hypoglycaemia may also occur insolid tumours of epithelial or mesenchymal origin.Hypoglycaemia caused by these types of tumours isreferred to as non-islet cell tumour hypoglycaemia(NICTH). NICTH is generally attributable to thesecretion of large amounts of incompletely processedinsulin-like growth factor II (IGF-II), also called‘big’-IGF-II [3].In this report, we describe the case of a patientwith metastatic gastrointestinal stromal tumour(GIST) who presented with a loss of consciousnessdue to hypoglycaemia caused by increased concen-trations of ‘big’-IGF-II.Case reportA 50-year old man was admitted to the hospitalbecause of loss of consciousness. He was known for alarge retroperitoneal GIST diagnosed three yearsearlier as a recurrence of a previously resectedsarcoma, at that time interpreted as a leiomyosar-coma. In the summer of 2001, the patient wasenrolled in a clinical trial with the tyrosine kinaseinhibitor imatinib mesylate (gleevec