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Severe paraneoplastic hypoglycemia secondary to a gastrointestinal stromal tumour masquerading as a stroke
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Dimitriadis, Georgios K., Gopalakrishnan, K., Rao, R., Grammatopoulos, Dimitris, Randeva, Harpal S., Weickert, Martin O. and Murthy, N. (2015) Severe paraneoplastic hypoglycemia secondary to a gastrointestinal stromal tumour masquerading as a stroke. Endocrinology, Diabetes & Metabolism Case Reports . 150062. doi:10.1530/EDM-15-0062 ISSN 2052-0573.
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Official URL: http://dx.doi.org/10.1530/EDM-15-0062
Abstract
We report the case of a 70-year-old previously healthy female who presented acutely to the Accident and Emergency department with left-sided vasomotor symptoms including reduced muscle tone, weakness upon walking and slurred speech. Physical examination confirmed hemiparesis with VIIth nerve palsy and profound hepatomegaly. A random glucose was low at 1.7 mmol/l, which upon correction resolved her symptoms. In hindsight, the patient recalled having had similar episodes periodically over the past 3 months to which she did not give much attention. While hospitalized, she continued having episodes of symptomatic hypoglycaemia during most nights, requiring treatment with i.v. dextrose and/or glucagon. Blood tests including insulin and C-peptide were invariably suppressed, in correlation with low glucose. A Synacthen stimulation test was normal (Cort (0′) 390 nmol/l, Cort (30′) 773 nmol/l). A computed tomography scan showed multiple lobulated masses in the abdomen, liver and pelvis. An ultrasound guided biopsy of one of the pelvic masses was performed. Immunohistochemistry supported the diagnosis of a gastrointestinal stromal tumour (GIST) positive for CD34 and CD117. A diagnosis of a non islet cell tumour hypoglycaemia (NICTH) secondary to an IGF2 secreting GIST was confirmed with further biochemical investigations (IGF2=96.5 nmol/l; IGF2:IGF1 ratio 18.9, ULN <10). Treatment with growth hormone resolved the patient's hypoglycaemic symptoms and subsequent targeted therapy with Imatinib was successful in controlling disease progression over an 8-year observation period.
Item Type: | Journal Article | ||||
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Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||
Library of Congress Subject Headings (LCSH): | Gastrointestinal stromal tumors -- Diagnosis, Hypoglycemia, Cerebrovascular disease | ||||
Journal or Publication Title: | Endocrinology, Diabetes & Metabolism Case Reports | ||||
Publisher: | BioScientifica | ||||
ISSN: | 2052-0573 | ||||
Official Date: | 21 September 2015 | ||||
Dates: |
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Article Number: | 150062 | ||||
DOI: | 10.1530/EDM-15-0062 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access | ||||
Date of first compliant deposit: | 21 March 2018 | ||||
Date of first compliant Open Access: | 22 March 2018 |
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