Tumour Induced Hypoglycaemia Treated Successfully With Growth Hormone
N Younis1, H Soran1, MP Howarth2, W Young1, H Zakhour3 & A Scott2
Introduction: haemangiopericytoma is a rare soft tissue tumour originating from pericytes. These are often large and slow growing tumours and manifest rarely as hypoglycaemia. We report a case of haemangiopericytoma-induced hypoglycaemia.
Case report: A 72-year-old lady presented with an episode of confusion. She had had similar episodes usually in the early morning hours. She was also known to have hypertension and a large bladder haemangiopericytoma (18 cm) removed surgically 7 years ago. On examination she was confused and disoriented. Abdominal palpation revealed a large mass arising from the pelvis. The rest of the examination was unremarkable. Full blood count, urea and electrolytes, ECG and chest X-ray were within normal limits. Her blood glucose was low 1.8 mmol/l. She was given dextrose infusion and responded dramatically. CT scan of abdomen showed a large mass arising from the broad ligament. A core biopsy was performed and Histology confirmed recurrence of the haemangiopericytoma. Hormonal studies showed low insulin, C-peptide and growth hormone. IGFBP3 was 2.7 mg/dl (0.7-4.4), IGF-II/IGF-I ratio was 20.8 (<10) suggesting non-islet tumour induced hypoglycaemia.
Over the next 14 days she had recurrent hypoglycaemic episodes despite frequent meals, worst in the early morning hours. Daily subcutaneous GH injection was successful in ameliorating the hypoglycaemic syndrome.
Discussion: The commonest cause of non-islet cell tumour hypoglycaemia is overproduction of IGF-II. Hypoglycaemia is induced by increased availability of free IGF-II to bind to IGF and possibly insulin receptors in the tissue. As demonstrated in this case, GH is an effective treatment if surgical removal of the tumour is not possible. Corticosteroids are also reported to be effective.
We thank Professor S Shalet & Dr P Trainer for advice and help in this work.