Late-Onset Non-islet Cell Tumor Hypoglycemia Associated with a Pleural Solitary Fibrous Tumor

A 53-year-old, non-diabetic lady was evaluated for worsening breathlessness over the past 1 year. She was diagnosed with a lung lesion a year ago, but the prevailing COVID-19 situation prevented her from seeking further evaluation. She began to have early morning episodes of symptomatic hypoglycemia over the previous 4 months, which were relieved with dextrose infusions. The evaluation showed low insulin, low C-peptide, and high insulin-like growth factor-2 to insulin-like growth factor-1 ratio. High-resolution computed tomography scan of the thorax showed a 19.5 cm x 16.6 cm x 23.8 cm mass in the left hemithorax, and a microscopic examination of a biopsy specimen of which was consistent with the diagnosis of solitary fibrous tumor. The patient underwent sternotomy with left anterior thoracotomy with successful excision of the fibrous tumor. Post-operatively, histopathological diagnosis of solitary fibrous tumor was confirmed. There were no further episodes of hypoglycemia, and the patient was completely recovered.