Hypoglycaemia in non-diabetic patients has a multitude of causes from exogenous insulin to paraneoplastic syndromes. We explore the importance of obtaining a golden sample, a serum blood sample, during the episode of hypoglycaemia, prior to reversal with treatment. The case herein describes a patient with recurrent episodes of unexplained hypoglycaemia which precipitated several hospital admissions. Standard screening tests did not detect any obvious cause for his disabling low blood glucose. Our patient was known to have an aggressive adenocarcinoma of the prostate which was being treated with third line therapy in the form of Stilboestrol. When this was taken into account it was hypothesized that tumour secretory products such as IGF-2 may be the cause of his hypoglycaemia. This was confirmed by both biochemical assay and immunohistochemical staining of previously taken and retained prostate biopsy samples from 13 years previously. The patient was initially treated with steroids but following recurrent hospital admissions with symptomatic hypoglycaemia it was decided to commence the patient on therapy with daily growth hormone injections. The use of GH in this context has previously been shown to be effective and the mechanism of action is that it is thought to disrupt the ratio of IGF binding proteins and therefore reduces the amount of available IGF-2 to have a tissue effect. The hypoglycaemia resolved and the patient remained normoglycaemic out of hospital. This case of IGF-2 mediated hypoglycaemia secondary to prostate cancer is rare and only the third such case described in the literature.
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.