title: [Recurrent hypoglycemia and a large intraabdominal tumor  in a 61-year-old woman].
abstract: METHODS
  A 61-year-old woman was found unconscious by her husband. The emergency doctor detected hypoglycemia (blood glucose 1.7 mmol/l). This was the first such event, the patient had not been known to have diabetes mellitus. At admission the physical examination and the laboratory findings revealed no abnormalities.
  
  
  METHODS
  A fasting test was aborted shortly after the start because of the onset of neurological symptoms. An insulinoma was excluded by detecting suppressed levels of insulin and C-peptide. Computed tomography of the abdomen revealed a mesenteric tumour of 9 cm in diameter, which was identified immunhistologically as a grade 1 follicular lymphoma (FL).  After exclusion of endocrinological causes the recurrent hypoglycaemia was diagnozed as part of a paraneoplastic syndrome associated with a non-islet cell tumour hypoglycaemia (NICTH) with a newly diagnosed FL.
  
  
  METHODS
  Specific medication with the CD20 antibody rituximab (375 mg/m2, once per week for a total of four cycles) was initiated. There were no further episodes of hypoglycaemia. After one year the patient remains free of any symptoms.
  
  
  CONCLUSIONS
  After exclusion of any endocrinological reasons for hypoglycemia, differential diagnosis should include NICTH as paraneoplastic syndrome. In rare cases a hematological malignancy may be the underlying disease. The specific treatment of this disease likewise represents the causal treatment of NICTH.
authors: Klinik für Innere Medizin III, Klinikum Magdeburg gGmbH. christoph.kahl@klinikum-magdeburg.de
authors: C
authors: C
authors: Kahl
authors: K
authors: K
authors: Jost
authors: A
authors: A
authors: Knauerhase
authors: M
authors: M
authors: Leithäuser
authors: M
authors: M
authors: Freund
authors: D
authors: D
authors: Bunke
authors: D
authors: D
authors: Rothacker
authors: R
authors: R
authors: Hampel
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008224:Lymphoma, Follicular / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008643:Mesentery / Q000473:pathology; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011379:Prognosis; D015641:Radiography, Interventional; D012008:Recurrence; D000069283:Rituximab; D014057:Tomography, X-Ray Computed
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab