Paraneoplastic Hypoglycemia: A Case Report

Abstract

Introduction: Paraneoplastic hypoglycemia unrelated to insulinoma is a rare cause of hypoglycemia and is due to paraneoplastic secretion of either IGFI, IGFII, or more rarely insulin Observation: We report a case of paraneoplastic hypoglycemia in a patient with metastases of an unknown primary. This is a 60-year-old patient admitted to the ward for recurrent hypoglycemia, the first of which was discovered following an apyretic coma. He has a history of hepatic and gluteal metastases from an undifferentiated carcinoma, the primary of which is unknown, followed in the oncology department and treated by chemotherapy. The biological assessment shows microcytic hypochromic anemia, hypoinsulinism <0.1mIU / l associated with a collapsed C peptide <0.15ng / ml (RV: 1.1- 4.4) with a concomitant glycemia of 21 mg/l. In view of the clinical context and the paraclinical explorations, the diagnosis of paraneoplastic hypoglycemia was retained after the elimination of the factitious origin and the insulinoma. The patient was put on diet, infusion of 5% glucose serum from which he was weaned after the introduction of prednisolone corticosteroid therapy: 60 mg per day with good tolerance and disappearance of hypoglycemia. Discussion/Conclusion: Paraneoplastic hypoglycemia is hypoglycemia most commonly caused by the overproduction of insulin-like growth factor 2 (IGF-2) and its precursors which can activate the insulin receptor. In general, large mesenchymal and epithelial tumors may be the cause. The diagnosis is confirmed by the discovery of an elevated IGF-2 / IGF-1 ratio. The basic treatment is surgical excision. Glucocorticoids are among the drugs that can be used in cases where surgery is not possible as a first line followed by other alternatives in case of failure.