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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Non-islet cell tumour hypoglycaemia in a patient with a well-differentiated gastric neuroendocrine tumour
  1. Judith Versluis1,
  2. Gerlof Valk2,
  3. Huub van Rossum3 and
  4. Margot Tesselaar1
  1. 1 Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  2. 2 Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Department of Clinical Chemistry, Netherlands Cancer Institute, Amsterdam, The Netherlands
  1. Correspondence to Judith Versluis, j.versluis{at}nki.nl

Abstract

A 61-year-old man, without noteworthy medical history, presented with complaints of progressive fatigue and flushes. Diagnostic imaging revealed a large tumour in the stomach with liver metastases, and histopathological examination showed a well-differentiated gastric neuroendocrine tumour (NET). After chemotherapy, everolimus was administered, and upon progression, PD-1 inhibitor PDR001 was started. Two weeks after the first gift, he was admitted with loss of consciousness and a blood glucose level of 1.6 mmol/L. Plasma insulin was below 0.5 mU/L, C-peptide level was 250 pmol/L, insulin-like growth factor (IGF)-II was 804 ng/mL, and pro-IGF-IIE level was 80 µg/L. Based on the clinical findings, the patient was diagnosed with non-islet cell tumour hypoglycaemia (NICTH) with an overproduction of pro-IGF-IIE and eventually IGF-II due to progressive metastatic well-differentiated gastric NET. NICTH is a very rare condition. It has been reported in several tumour types but has never been described as a consequence of NET.

  • Endocrine Cancer
  • Metabolic Disorders

https://doi.org/10.1136/bcr-2019-231069

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    Footnotes

    • Contributors All authors declare that they have made substantial contributions to this case report by revising the work critically for its intellectual content. The first author has written the case report and processed the comments by the other authors. Final approval of the version published is given by all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Next of kin consent obtained.