Endocrine Abstracts (2007) 13 P19

Spontaneous recurrent hypoglycaemia due to metastatic gatrointestinal stromal tumour (GIST)

Binu Krishnan, Aikaterini Theodoraki & Helen Ward

St.Peter’s Hospital, Chertsey, United Kingdom.

A 75-year old gentleman presented with symptoms of increasing lethargy, loss of appetite associated with weight loss and constant micturition. A CT scan showed extensive peritoneal mass in the lower abdomen and pelvis with disseminated intraperitoneal malignancy. A CT guided biopsy confirmed a poorly differentiated tumour. Immunohistochemistry showed that all the cytokeratin markers were negative, but vimentin was positive and CD117 (c-kit) was strongly positive, indicating that it was a malignant GIST. In the following two weeks, the patient experienced recurrent episodes of “blackouts” associated with excessive sweating and was admitted to hospital. The patient showed a suboptimal response to short synacthen test. Blood tests during an episode of spontaneous hypoglycaemia revealed.

InvestigationsResultsNormal range
Blood glucose1.4 mmol/L4–6.4
Insulin12 pmol/L0–180
C-peptide154 pmol/L180–630
ACTH20 ng/L0–50
Cortisol248 nmol/LReduced response to a glucose of 1.4 mmol/L
Growth hormone 4.6 mu/L0–5
IGF I2.9 nmol/L6–36
IGFII61.7 nmol/L37.2–82.1
IGF II:IGF I ratio21.3<10

While on the ward, he had recurrent episodes of spontaneous hypoglycaemia requiring correction with 10% dextrose infusion. There was no improvement in blood sugars despite treatment with hydrocortisone and octreotide. As an elevated IGF II:IGF I ratio confirmed the diagnosis of non-islet cell hypoglycaemia, the patient was commenced on Growth hormone 0.02 mg/kg subcutaneously daily with successful stabilization of blood sugars.

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