Endocrine Abstracts (2018) 55 WH1 | DOI: 10.1530/endoabs.55.WH1

A daughter's diagnosis

Laxmi Manohar Rao Balmuri1, Lauren Morris2, Clare Mumby1, Jennifer Beynon3 & Basil Issa3

1Manchester Royal Infirmary, Manchester, UK; 2Salford Royal Foundation Trust, Manchester, UK; 3Wythenshawe Hospital, Manchester, UK.

Case: An 89 year old gentleman was admitted to hospital following a collapse at home. His capillary blood glucose was found to be 1.4 mmol/l by the paramedics. The patient had experienced multiple collapses at home in the preceding 2 weeks. Each time, he had been found to be hypoglycaemic but treated and discharged from A&E. He complained of reduced appetite, weight loss and change in bowel habit. The patient’s past medical history included a large fibroma of the left pleura which was being managed conservatively. He was also known to have atrial fibrillation, COPD, bronchiectasis and CCF with severe systolic impairment.

Investigations: Blood tests revealed an elevated CRP (45 mg/l) with normal WCC (7.9×109/l), mild anaemia (Hb 116 g/l), elevated ALP (146 IU/l) and normal renal function. A CT scan showed the known large pleural fibroma and a new smaller lesion in the right upper lobe of uncertain aetiology. Following transfer to the endocrinology ward, the patient experienced a further episode of hypoglycaemia and the venous glucose was found to be 1.9 mmol/l. Insulin and C-peptide levels were also found to be low at 11 pmol/l and <94 pmol/l respectively. A SST was normal and IGF-1and IGF-2 levels analysed. Results showed IGF-2:IGF-1 ratio 16.7 (<10). Despite regular feeding, supper and overnight snacks he remained significantly hypoglycaemic especially overnight with no awareness of symptoms. He was commenced on Prednisolone 30mg daily and his hypoglycaemia improved.

Discussion: Doege-Potter syndrome is a rare cause of hypoglycaemia. In this condition, hypoglycaemia is mediated by the secretion of IGF-2 from a fibrous tumour. Prompt recognition and management is essential. Surgical resection of the lesion is curative, but management can be difficult in patients that are not fit for surgery. Options include chemotherapy, embolisation, glucocorticoids or growth hormone.

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