Endocrine Abstracts

Non-islet cell tumour hypoglycaemia (NICTH) is a relatively rare form of hypoglycaemia affecting patients with solid tumours originating from mesenchymal and epithelial cells. The hypoglycaemia is due to the excessive secretion by these tumours of high molecular weight insulin-like growth factor (IGF)-2 or pro IGF-2 which stimulate the insulin receptor and suppresses GH secretion by negative feedback mechanism, resulting in hypoglycaemia. The causative tumours may present with hypoglycaemia which may also present first and lead to the diagnosis of the tumour. The hypoglycaemic episodes may become more frequent and severe resulting in serious and detrimental effects on quality of life. Complete surgical removal of the causative tumour may be curative. Otherwise, high doses of long-term glucocorticoids may be required to prevent hypoglycaemia. We are presenting a 67-year-old male who presented to our emergency department in October 2023 with hypoglycaemia. He gave history of episodes of hypoglycaemia which started and increased in frequency over the preceding 4 to 5 weeks, associated with blurring of vision, sweating and confusion. In 2017 he was diagnosed with a jejunal gastrointestinal stromal tumour (GIST), with liver and omental metastases and treated with Imatinib till March 2023. Of late the disease progressed, but could not be started on Umatinib, a second line medication, due to his other associated illnesses of heart failure, chronic renal impairment (CKD3) and atrial fibrillation. Following infusion of high concentration dextrose, he was given intravenous hydrocortisone, then switched to oral prednisolone of which he was discharged on 60 mg per day, with a plan to gradually reduced to 40 mg to prevent hypoglycaemia.

Conclusion: Patients with GISTs, who show tendency to persistent hypoglycaemia, should be routinely evaluated for NICTH from the outset. Complete removal of the underlying tumour should be performed if possible. Otherwise, adequate dosing with glucocorticoids may be helpful.