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The palliative management of non-islet cell tumour hypoglycaemia with glucocorticoids and somatostatin analogues in an unresectable hepatocellular carcinoma

Lookup NU author(s): Dr Alex North, John Hammond

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Abstract

Non-islet cell tumour hypoglycaemia (NICTH) results from paraneoplastic insulin-like growth factor-II (IGF-II) secretion and its potent insulin-like effect. It causes recurrent, often severe, hypoglycaemic episodes, which is detrimental to quality of life. There is limited evidence regarding best supportive care in unresectable tumours. A 76-year-old woman presented with hypoglycaemic collapse. A new diagnosis of unresectable hepatocellular carcinoma (HCC) was made. The IGF-II:IGF-I ratio was 11.0, which confirmed NICTH. The octreoscan showed avid disease. The main problem was symptomatic nocturnal hypoglycaemia. Curative treatment options were not possible in this case and treatment focused on preventing symptomatic hypoglycaemia. Inpatient treatment was with high carbohydrate nasogastric (NG) feeds, prednisolone and somatostatin analogue (octreotide) infusion. Once stabilised, the patient was discharged with NG feeds, prednisolone and a long-acting somatostatin analogue (sandostatin). The patient received successful end-of-life care with her family as per her wishes, without requiring readmission. The treatments were well-tolerated and effective in preventing symptomatic hypoglycaemic episodes. The combination of high carbohydrate NG feed with prednisolone and somatostatin analogues was effective in preventing symptomatic hypoglycaemia. Somatostatin analogues had a useful steroid sparing role. Larger case series are warranted to clarify the management of NICTH patients with placebo-controlled studies to determine the role of somatostatin analogues.

Publication metadata

Author(s): North AS, Thakkar RG, James RA, Hammond JS

Publication type: Article

Publication status: Published

Journal: Annals of the Royal College of Surgeons of England

Year: 2022

Volume: 104

Issue: 6

Pages: e180-e182

Print publication date: 06/06/2022

Online publication date: 08/02/2022

Acceptance date: 02/04/2018

ISSN (electronic): 0026-6493

Publisher: Royal College of Surgeons of England

URL: https://doi.org/10.1308/rcsann.2021.0269

DOI: 10.1308/rcsann.2021.0269

PubMed id: 35133207

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