Endocrine Abstracts

Introduction: We report a patient with a solitary fibrous mesothelioma producing insulin -like growth factor (IGF) II who presented with recurrent episodes of early morning acute disorientation and agitation. .
On examination he was noted to have decreased air entry at the right base and midzone and a mass in the right hypochondrium. . Radiologic imaging showed a large pleural based mass which almost completely filled the right hemithorax. When symptomatic hypoglycaemia was demonstrated blood samples for the determination of insulin, C -peptide, IGF1, total IGF11 and Growth Hormone concentrations were analysed. The laboratory data showed a combination of suppressed insulin (less than 10 picamol per litre ), C peptide(less than 94 picamol per litre) and growth hormone (less than 0.55mU per litre) and elevated IGF11 ratio of 25.3 (reference range below 10) all of which were associated with non-islet tumour associated hypoglycaemia.
The hypoglycaemia was treated with 10% dextrose and subsequent oral deltacortril. Tumour resection revealed a 5kg well encapsulated tumour which histology confirmed to be a fibrous mesothelioma.
24 hours post resection the dextrose infusion rates decreased by 35% and the deltracortril was discontinued over time. Follow up shows that he is free from disease and hypoglycaemia. Prognosis is good and the risk of recurrence is low.
Conclusion: This case reflects a rare cause of fasting hypoglycaemia. In this case appropiate biochemical investigations included the measurement of IGF 11. The treatment of choice is removal of the tumour and treatment of hypoglycaemia with dextrose infusion with oral steroids and /or growth hormone.