Paraneoplastična hipoglikemija kod pacijenta sa recidivom fibroznog tumora pleure

Abstract

BACKGROUND: Solitary fibrous tumor of pleura represents a prototypical mesenchymal neoplasm that induces non-islet cell tumor hypoglycemia due to overproduction of insulin-like growth factor 2, named Doege Potter syndrome. CASE PRESENTATION: An 86-year-old man, non-diabetic, was admitted to hospital with a few months history of repetitive hypoglycemic symptoms and documented low blood glucose of 1.9 and 1.2 mmol/L on two occasions when he lost consciousness. His medical history was notable for primary pleural fibroma which was resected twenty years previously and for tumorous mass of right pulmonal lobe 103mm described on CT chest scan for respiratory infection six months prior to hospitalization. During hospitalization hypocorticism and hypoptuitarism were ruled out. He spontaneously developed mild neuroglycopenic episodes, when we confirmed hypoinsulinemic hypoglycemia accompanied with suppressed levels of growth hormone and IGF1, and IGF2 : IGF1 ratio of 7, which was all suggestive of paraneoplastic etiology. The response of glucose in Glucagon test was adequate. Beta-hydroxybutyrate was not done due to technical limitations. Abdominal MRI showed a few well-circumscribed cysts in the liver and hemangioma. Octreoscan revealed zone of diffuse increased uptake in right hemithorax. Subsequently, he was started on prednisolon for COPD exacerbation with which his hypoglycemic episodes subsided. Patient declined surgery and he was released with corticosteroid therapy. CONCLUSIONS: We report a case of hypoinsulinemic hypoglycemia in a patient with suppressed levels of hGH and IGF1 and higher-than-normal IGF2 : IGF1 ratio, along with recurrent pleural tumor which is somatostatine-receptor positive.