Hypoglycemia Refractory in Patient with Metastatic Gastrointestinal Stromal Tumor (GIST): Case Report and Literature Review

Abstract

A case of NICTH secondary to gastrointestinal stromal tumor (GIST) is described, male patient admitted to the emergency referring asthenia and drowsiness, and measured blood glucose of 20mg/dL. Patient continued to present episodes of recurrent hypoglycemia: 33/55/32mg/dL, even with continuous reposition of 10% glucose solution. Hypoglycemia can be related to several tumors, including islet cell and non-islet cell tumors. Non-islet cell tumor hypoglycemia (NICTH) is a rare and serious complication of malignancy, and its presence is usually associated with a poor prognosis. The most common cause of this type of hypoglycemia is tumor overproduction of insulin-like growth factor II (IGF-II), which stimulates the insulin receptor, leading to decreased insulin and glucagon levels. The diagnosis of NICTH is based on clinical and laboratory findings. Patients with NICTH have low serum concentrations of insulin and C-peptide during hypoglycemia. The treatment of this condition is related to the control of the underlying neoplasia. In patients who are unable to undergo invasive procedures, the use of corticosteroids is a good treatment option, leading to normalization of glycemia. Its management is of unquestionable importance to ensure the patient’s quality of life. A review of the literature on epidemiology, diagnosis and treatment of this complication follows.