Endocrine Abstracts

Fasting hypoglycaemia may occasionally be caused by non islet cell tumours (NICTH). Mostly they are large retroperitoneal, intra-abdominal or intrathoracic tumours that are slow growing though malignant. We report a case of recurrent hypoglycaemia associated with metastatic ovarian carcinoma.

About 66-year-old lady was admitted with increasing abdominal distension and shortness of breath over 6 weeks duration. There was no significant past medical history except hypertension. General examination was unremarkable. Systemic examination showed evidence of ascites.

Computed tomographic scan confirmed the presence of ascites with an ovarian mass, extensive peritoneal deposits and a nodule at the lung base. Histology confirmed the presence of ovarian carcinoma. It was felt surgery was not appropriate due to extensive disease. She required repeated ascitic fluid drainage and was treated with chemotherapy (Carboplatin, Taxol and dexamethasone).

Her general condition showed a slow decline but 12 months after her initial diagnosis, she was admitted with collapse associated with severe recurrent symptomatic hypoglycaemia. Insulin <0.8 mU/l (<5) and c-peptide <166 pmol/l (120–600) were appropriately suppressed during episodes of hypoglycaemia (serum glucose 2.0 mmol/l) however Serum IGF-II was significantly raised at 94.0 nmol/l. Serum IGF-I was suppressed at 4.2 nmol/l giving an IGF-II: IGF-I ratio of 22.4 (normal <10).The prognosis from her carcinoma was considered to be very poor. Dietary measures with regular carbohydrate were initially helpful. Dextrose infusion was then required overnight and finally prednisolone was added with reasonable control of her symptomatic hypoglycaemia. She died shortly afterwards.

The most common cause of NICTH is hepatocellular and gastric carcinoma. Metastatic ovarian carcinoma has not previously been reported as a cause of NICTH. A variety of management strategies have been suggested including growth hormone and, as in this case, glucocorticoids.