A 73-year-old woman presented with hypoglycaemic collapse and a capillary blood sugar of 0.7 mmol/l and required continuous intravenous dextrose to maintain euglycaemia. There was two-week history of night sweats and overnight snacking. One year previous, the patient had been diagnosed with a gastric adenocarcinoma and had undergone a sub-total gastrectomy and chemo-radiotherapy. Physical examination was unremarkable. Liver function was normal except an elevated alkaline phosphotase (266 IU/l) and a low albumin (29 g/l). Clotting profile and renal function were normal. Ultrasound examination of the liver revealed multiple lesions presumed to be of metastatic origin. Normal synthetic function excluded liver failure as the cause of hypoglycaemia. A short synacthen test was normal. Hypoglycaemia was associated with the following: Insulin <10 pmol/l, C-peptide <94 pmol/l, Insulin Like Growth Factor (IGF)-I < 2 nmol/l, and IGF-II 136.5 nmol/l. The findings were consistent with the diagnosis of Non-Islet Cell Tumour Hypoglycaemia (NICTH).
A single course of chemotherapy resulted in some improvement in the level of hypoglycaemia but the patient was unable to undergo further treatment due to side effects. High dose prednisolone and overnight enteral feeding effected significant improvement but nocturnal hypoglycaemia remained refractory. Euglycaemia was eventually achieved with enteral feeding, 30 mg Prednisolone, and 2 U growth hormone. Two months after presentation the patient died of disease progression.
NICTH is a rare but important cause of hypoglycaemia complicating malignancy. This case illustrates a role for growth hormone in combination with other measures when more definitive treatment is unavailable.
06 - 07 Nov 2006
Society for Endocrinology