Hypoglycemia in the setting of advanced gastrointestinal stromal tumor.

摘要: We report a rare case of symptomatic hypoglycemia in patient with intra-abdominal recurrence previously resected gastrointestinal stromal tumor (GIST). The is 65-year-old woman who underwent resection large abdominal mass arising from the stomach, histologically diagnosed as high-grade leiomyosarcoma. She was lost to follow up. Five years later, recurred; core biopsy demonstrated CD 117-positive, spindle-cell tumor, consistent GIST. placed on Gleevec, there evidence multifocal disease, but imaging revealed only mild improvement. Subsequently, her clinical status deteriorated, and she hospitalized for dehydration, vomiting, mental changes. Her blood glucose admission 22 mg/dL, dextrose infusion (50%) necessary maintain adequate levels. Measurements insulin, proinsulin, c-peptide, beta-hydroxybutyrate, thyroid-stimulating hormone were normal, cosyntropin stimulation glucagon response tests. Suspicions arose tumor-secreted insulin-like factor. dominant 44-cm recurrence, immediate rebound hyperglycemia, followed by complete normalization discharged postoperative Day 5 without symptoms or alive disease at 20 months. Paraneoplastic syndromes occur 15 per cent patients known malignancies (e.g., lung cancer metastatic carcinoid), are rarely reported setting Hypoglycemia most often observed presence insulinoma isolated reports GIST exist. Overexpression growth factor II thought be mechanism action. Supportive management palliative debulking recommended when possible.