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Case report
Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin
  1. Justin S Bhullar1,
  2. Joseph MWS Leung1 and
  3. Mohammed S Almehthel2
  1. 1Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Endocrinology, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Joseph MWS Leung; jmleung{at}


A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin. Management involved a multimodal approach in an attempt to reduce tumour burden and achieve euglycaemia, which proved to be a significant challenge in the face of refractory hypoglycaemia despite the administration of multiple prohyperglycaemic agents in combination. Unfortunately, given the burden of metastatic disease and multiple medical complications that ensued, the patient passed away. This case highlights the clinical history of a NET co-secreting serotonin and insulin, the use of combination therapy in the treatment of refractory hypoglycaemia in a metastatic insulin-producing tumour and emerging therapeutic modalities in the treatment of these rare malignancies.

  • endocrinology
  • oncology
  • endocrine cancer

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  • Contributors JSB wrote the article. JMWSL compiled the data for the case report and edited the article. MA edited the article and supervised the writing of this case report.

  • 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.

  • Patient consent for publication Next of kin consent obtained.

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

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