title: A case of extragastrointestinal stromal tumor complicated by severe hypoglycemia: a unique presentation of a rare tumor.
abstract: Non-Islet Cell Tumor Hypoglycemia (NICTH) is a rare paraneoplastic cause of hypoglycemia arising from excess tumor production of insulin-like growth factor. The objective of this report is to describe an unusual case of Extragastrointestinal Stromal Tumor (EGIST) associated NICTH.
  
  
  
  A 64 year-old African female was brought to the emergency room with a 1-month history of recurrent syncope, weight loss, and abdominal bloating. Serum blood glucose was discovered to 39 mg/dL, when insulin, proinsulin, and C-peptide were suppressed. Computed tomography scan revealed a diffuse extraintestinal metastatic disease process, and a biopsy confirmed the diagnosis of an Extragastrointestinal Stromal Tumor (EGIST). IGF-I and II levels were 27 ng/ml and 262 ng/ml respectively, and the ratio of IGF-II to IGF-I was calculated as 9.7:1, suggestive of IGF-II-mediated NICTH. Acutely, the patient's hypoglycemia resolved with dextrose and glucagon infusion. Long-term euglycemia was achieved with prednisone and imatinib therapy.
  
  
  
  NICTH should be considered when hypoglycemia occurs in the setting of low serum insulin levels. Whereas definitive treatment of EGIST involves surgical resection, immunotherapy with tyrosine kinase inhibitors and corticosteroids have been shown to alleviate hypoglycemia in cases where surgery is delayed or not feasible.
authors.affiliation: Departments of Medicine, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Zeb
authors.initials: Z
authors.lastname: Saeed
authors.affiliation: Departments of Medicine, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Solaema
authors.initials: S
authors.lastname: Taleb
authors.affiliation: Departments of Medicine, Indiana University School of Medicine, Indianapolis, USA. cevansmo@iu.edu.|Celllular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, USA. cevansmo@iu.edu.|Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, USA. cevansmo@iu.edu.|Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, 635 Barnhill Drive MS 2031A, Indianapolis, IN, 46202, USA. cevansmo@iu.edu.|Roudebush VA Medical Center, Indianapolis, IN, 46202, USA. cevansmo@iu.edu.
authors.forename: Carmella
authors.identifier: 0000-0001-7764-8663
authors.initials: C
authors.lastname: Evans-Molina
mesh_terms: D015415:Biomarkers; D001706:Biopsy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology*; D007150:Immunohistochemistry; D008875:Middle Aged; D012983:Soft Tissue Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D017154:Stromal Cells / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers
keywords: Extragastrointestinal stromal tumor (GIST); Non-islet cell tumor hypoglycemia; Tumor induced hypoglycemia