Malignant hypoglycemia associated with a large mesenchymal tumor: Case report and review of the literature

PURPOSE To examine hypoglycemia associated with a non-islet-cell tumor caus ed by the secretion of abnormal insulinlike growth factors. PATIENT AND METHODS We describe a 54-year-old woman with a massive solitary fibrous tumor who e xperienced worsening hypoglycemia with suppressed levels of insulin and ins ulinlike growth factor I but abnormally "normal" levels of insulinlike grow th factor II. RESULTS Efforts to control her symptoms with frequent meals, prednisone, and intrav enous dextrose infusions were only partially successful. Attempts at reduci ng the tumor size by embolizing its arterial supply and percutaneous alcoho l injections were unsuccessful, and the patient died 24 hours after surgica l debulking. DISCUSSION Patients with non-islet-cell tumor hypoglycemia usually have abnormally hig h levels of an incompletely processed precursor of insulinlike growth facto r II, which is more bioavailable than the normal molecule. In some patients , treatment with corticosteroids and growth hormone increases blood sugar l evels, but the most effective therapeutic approach is to resect or debulk t he tumor.