B154

A rare cause of hypoglycaemia in metastatic pancreatic adenocarcinoma

Ellie Broughton, Alistair Watts, Matthew Oldfield

Kingson Hospital NHS trust, Kingston, Surrey, UK

A 78 year old gentleman with metastatic pancreatic adenocarcinoma was admitted with recurrent hypoglycaemia. The patient had a Whipple procedure three years previously and only recently required palliative chemotherapy for extensive liver and abdominal lymph node metastases.

On admission his blood glucose levels were persistently below 2mmol/L, with no improvement with continuous intravenous dextrose therapy. Further blood tests revealed low insulin, C-peptide and IGF (insulin-like growth factor)-I levels and high IGF-II and IGF-I:IGF-II ratio. These were consistent with the diagnosis of non-islet cell tumour-induced hypoglycaemia (NICTH).

A review of the literature shows that this unusual condition has been associated with many benign and malignant tumours. It is caused by the production of an abnormally large molecular form of IGF-II. The so-called big IGF-II has an increased bioavailability and potentiates hypoglycaemia.

Management of NICTH includes treatment of the primary tumour, with surgery or chemotherapy, and pharmacological treatments such as corticosteroids, growth hormone and octreotide. None of these are tried and tested and this patient showed no improvement with diazoxide and corticosteroid treatment.

It is likely that this is an under-diagnosed cause of hypoglycaemia in cancer patients and further research is required for greater understanding and to develop an effective treatment.