Paraneoplastic Hypoglycemia Leading to Insulin Independence in a Patient With Type 1 Diabetes

• DOI: 10.1016/j.aace.2021.05.006
• Publication Date: 2021-05-28T08:42:05Z
• Authors: Nami Safai Haeri; Hussain Mahmud; Mary T. Korytkowski
• Keywords: Discontinuation

Non-islet cell tumor hypoglycemia (NICTH) is an uncommon paraneoplastic syndrome associated with mesenchymal neoplasms such as gastrointestinal stromal tumors (GISTs). We report the case of a patient type 1 diabetes (T1D) and recurrent GIST who not only required discontinuation insulin therapy but also continuous parenteral glucose infusions to prevent hypoglycemia.A 59-year-old woman 24-year history T1D presented frequent episodes symptomatic despite reductions in her therapy. Laboratory workup revealed undetectable C-peptide, low insulin-like growth factor (IGF) 1, normal IGF-2, elevated IGF-2:IGF-1 ratio. Medical management prednisone alone and, later, combination octreotide did reduce hypoglycemic episodes. Eventually, during hospitalization for severe hypoglycemia, she was treated discharged intravenous dextrose infusion. She ultimately around-the-clock infusions, which helped maintain what believed acceptable quality life remaining weeks.NICTH characterized by excessive production IGF-2 or pro-IGF-2, leading unrestricted uptake peripheral tissues hypoglycemia. A diagnosis NICTH can be made on basis IGF-1 levels plasma IGF-2. Tumor resection most definitive treatment NICTH.This resistant due recurrence enlarging GIST. all euglycemia.