Steroid responsive hypoglycaemia in a patient with spindle cell sarcoma

Abstract

A 76 year old gentleman not known to be diabetic presented with confusion and agitation. On admission he had a blood glucose reading of 2.1mmol/l and clinical examination confirmed an abdominal mass. He was initially resuscitated with intravenous dextrose but continued to experience hypoglycemic episodes. Urine sulphonylurea, serum insulin, pro-insulin and c-peptide levels tested at the time of hypoglycemia were satisfactory. There was no ketonaemia and the short synacthen test showed adequate response. His IGF 2 and IGF2:IGF1 ratio was elevated. An abdominal Ultrasound and CT scan were inconclusive as to the nature of the mass, so biopsy and histology were organized which confirmed a spindle cell neoplasm. To maintain euglycaemia, he had dietician input for complex carbohydrate meals and regular scheduled snacks, but as this failed to sustain his euglycaemia, he was then started on steroid therapy. He had a good response to the dexamethasone. Unfortunately, as curative therapy of the spindle cell tumor was not an option for him, he was referred for palliative follow-up.