Endocrine Abstracts

Non-islet cell tumour (NICTH) hypoglycaemia is a rare clinical phenomenon. IGF-II mediated hypoglycaemia is the most common cause of NICTH encountered in clinical practice. When observed, it is most commonly in the setting of epithelial or mesenchymal neoplasms. Colorectal cancer is an uncommon malignancy associated with IGF-II mediated hypoglycaemia. We present the case of a 59 year old gentleman with no known history of diabetes who presented acutely to hospital with symptomatic hypoglycaemia with a glucose of 0.4mmol/l. He had a past medical history significant for metastatic colorectal cancer to liver. He had normal synthetic liver function, normal renal function and passed a short synacthen test subsequent to admission. While in hospital the patient had a serum glucose of 2.0mmol/l recorded with an appropriately suppressed insulin and C-peptide level. IGF-1 and IGF-II levels were subsequently sent and an IGF-II:IGF-I ratio of 11.5 confirmed a diagnosis of IGF-II mediated hypoglycaemia. This gentleman was started on escalating course of oral steroids and IV dextrose to maintain his blood glucose and was transferred under the care of his oncology team to commence on chemotherapy to treat his underlying malignancy. This led to a short term improvement in his blood glucose but sadly he passed away from his malignancy within months of his initial presentation with symptomatic hypoglycaemia.