Recurrent Neuroglycopenia: Do Not Forget Non-islet Cell Induced Tumor Hypoglycemia
Hypoglycemia is one of the most common medical emergencies. It is often iatrogenic in patients with diabetes. However, recurrent spontaneous hypoglycemia in nondiabetic individuals is rare and merits attention. The medical causes of hypoglycemia are well-known. Nonislet cell tumor hypoglycemia (NICTH) is a rare entity and the second most common cause of tumor related hypoglycemia after insulinomas. The reported incidence of NICTH ranges from 2 to 15 cases per million.1,2 However, NICTH may be under-reported due to unreported and undiagnosed cases. Non-islet cell tumor hypoglycemia presents with wide array of symptoms that range from hypoglycemia to neuroglycopenic symptoms that can mimic other clinical conditions such as cerebrovascular accidents and syncope. Thus, delay in diagnosis or misdiagnosis is the norm. A variety of benign and malignant tumors are associated with NICTH. Among these are sarcomas and hepatic carcinomas which are responsible for two-thirds of the cases of hypoglycemia.3,4Among the former, fibrosarcomas are most commonly associated with paraneoplastic hypoglycemia. However, no histological variant is exempt. Here, we intend to highlight the association of well-differentiated liposarcoma with NICTH, which has not been described before. This report has highlighted the difficulty in diagnosis of such an unusual case that presented with a very common symptom and illustrated the surgical and medical management of NICTH.
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