[Hypoglycemia in a patient with pleural solitary fibrous tumor and response to pasireotide]

Abstract

Introduction: hypoglycemia is a common and multifactorial clinical condition. A rare cause is that associated with non-islet cell tumors.

Objective: to report our experience on the management of severe hypoglycemia in a patient with solitary pleural fibrous tumor and his response to pasireotide.

Clinical case: 63-year-old patient with a history of glomerulonephritis, hypothyroidism, arterial hypertension and a one-year diagnosis of solitary pleural fibrous tumor. Referred to endocrinology due to hypoglycemia for 6 months. Acromegaloid features were confirmed. Laboratory: Hct 36%, Hb 11.9 g/dl, GB 3570/mm3 (Eo 2%, Ba2%, Bac 4%, NS 36%, Li 30%, Mo 14% metamyelocytes 1%, myelocytes 11%), platelets 120,000 /mm3, ESR 10 mm, CRP 9 mg/L, TP 114%, TTPK 25 sec, blood glucose 57 mg/dL, renal function, hepatogram and lipid profile without particularities. IGF-1 84 ng/ml (VR 57 - 188), C-peptide 0.10 ng/ml (VR 1.10 - 4.40), somatotropin 0.98 ng/ml (VR up to 2.5) and basal insulin 0.4 uU/ml (VR 2.6 - 24) . IFG-2 measurement is not available in Argentina. A chest CT showed a pleural tumor measuring 13 cm. Without possibilities of surgical resection and without response to chemotherapy. Treatment was started with infusion of 25% dextrose, dexamethasone, pasireotide with good response. The patient died due to an infectious complication.

Conclusion: pasireotide could be a therapeutic alternative in cases that are not candidates for surgery or refractory to other medical treatment.