Endocrine Abstracts

Introduction: Hypoglycemia is a common medical emergency, occurring more frequently in diabetic patients. Rarely induced by a tumor cause, but it is important to recognize the syndrome when it occurs. We report the case of a 64-year-old female patient presenting with hypoglycemia on pancreatic tumor complicated by bilithorax.

Observation: 64-year-old female patient, known diabetic for 1 year on Glimeperide 3 mg and Metformin 1 g, hypertension for 1 year on Valsartan, presented to the emergency department with abdominal pain and vomiting for 1 month, associated with mucocutaneous jaundice. Clinical examination: patient conscious, hemodynamically and respiratorily stable; hypoglycemia 0.40 g/l, abdominal examination: ascites with collateral venous circulation and epigastric tenderness. On workup; ASAT: 58 (1.7 N) ALAT 180 (5 N) PT: 43% CRP: 48; tumor markers CA 19-9 and CEA elevated Abdominal MRI: heterogeneous swollen appearance of the body and tail of the pancreas measuring 36 mm in maximum thickness and extending over 7 cm, with infiltration of the peripancreatic fat and moderate peritoneal effusion. Chest X-ray: opaque right pulmonary hemichamber; bilious drainage fluid Cytochemical and bacteriological studies of ascites puncture fluids and pleural effusion were requested.

Discussion: Hypoglycemia is defined as a lower-than-normal blood glucose concentration, traditionally defined biochemically as plasma glucose <3.5 mmol/l. Occasionally, hypoglycemia can be induced by tumors, including insulin-secreting pancreatic tumors and IGF2-secreting non-islet cell tumors. The mechanisms that can cause hypoglycemia in pancreatic tumors are: (1) insulin or insulin-like activity produced by the tumor, (2) decreased gluconeogenesis, (3) disturbed glucagon metabolism and (4) increased glucose utilization by the tumor. Local effects of the tumor on the liver parenchyma may also play an important role.

Conclusion: Hypoglycemia of pancreatic tumor origin remains rare, and treatment is based on tumor control.