Non-Islet Cell Tumour Hypoglycaemia in a patient with recurrent meningeal haemangiopericytoma : A Case Report
Madhurima Vidyarthi1, Jonathan Benjamin2, Jonathan Shamash3 & Frederick Nkonge1
A 43 year-old presented with a first seizure in 1990 and a history of three distinct episodes of expressive dysphasia over the last 27 years. His CT scan showed a large middle cranial fossa tumour. He underwent urgent craniotomy and the tumour at resection was noted to be friable and covered with a number of small blood vessels. Frozen section was reported as angioblastic meningioma. He remained well for six years after which he presented with local recurrence of his tumour. The lesion was resected once more and histology this time confirmed the diagnosis of a haemangiopericytoma. This was treated with cranial radiotherapy in 1996 and his brain imaging remained normal. In July 2003 he had a pathological fracture right femur due to metastasis of his spindle cell tumour. He underwent hemiarthroplasty and subsequent radiotherapy. A CT scan at that point confirmed liver metastases. In March 2005, he was admitted with symptoms suggestive of early morning hypoglycaemia and capillary blood glucose of 1.8 mmol/l. Blood glucose levels were managed initially with 50% glucose. Serum insulin levels were found to be suppressed with normal IGF-1 levels and raised pro-IGF2 levels. He required high doses of oral prednisolone and increased oral glucose. He was trialled unsuccessfully on octreotide. Growth hormone therapy was discussed with the patient who rejected it. He was finally stabilised on interferon alfa-2b 4.5 million units daily and dexamethasone. Unfortunately, his disease progressed with local recurrence and left flank metastases and he died a year later. Cranial haemangiopericytomas are uncommon and may rarely cause hypoglycaemia due to IGF2 production. This may be difficult to control as evidenced by our case and require the input and expertise of a multi-disciplinary team as well as the combination of therapies.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.