title: A mitotic cause of Whipple's triad: non-islet cell tumour hypoglycaemia in incurable low-grade malignancy.
abstract: A 74-year-old man with known metastatic haemangiopericytoma presented with neuroglycopaenic symptoms of confusion and light-headedness secondary to recurrent episodes of fasting hypoglycaemia, which resolved with oral carbohydrate intake. Investigations for hypoglycaemia revealed it to be non-insulin mediated, and subsequently due to a rare paraneoplastic phenomenon termed as non-islet cell tumour hypoglycaemia caused by tumoural overproduction of high molecular weight insulin-like growth factor-II. Despite his underlying malignancy being incurable, directed multimodality treatment involving regular oral carbohydrate intake, glucocorticoid therapy and recombinant human growth hormone was effective in relieving symptoms of hypoglycaemia. We discuss the importance of a systematic diagnostic approach to hypoglycaemia fulfilling Whipple's triad, as specific therapies can be invaluable to improving quality of life.
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Lee
authors.affiliation: Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Twigg
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D003907:Dexamethasone / Q000008:administration & dosage; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004244:Dizziness / Q000209:etiology; D005938:Glucocorticoids / Q000008:administration & dosage; D006393:Hemangiopericytoma / Q000150:complications* / Q000188:drug therapy; D019382:Human Growth Hormone / Q000008:administration & dosage; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000209:etiology; D007335:Insulin-Like Growth Factor II / Q000096:biosynthesis*; D007340:Insulinoma / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D008113:Liver Neoplasms / Q000150:complications* / Q000188:drug therapy; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life
chemical_list: D018931:Antineoplastic Agents, Hormonal; D004040:Dietary Carbohydrates; D005938:Glucocorticoids; D019382:Human Growth Hormone; D007335:Insulin-Like Growth Factor II; D003907:Dexamethasone