Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin

A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin....

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Bibliographic Details
Published in:BMJ case reports 2020-11, Vol.13 (11), p.e236659
Main Authors: Bhullar, Justin S, Leung, Joseph MWS, Almehthel, Mohammed S
Format: Article
Language:English
Subjects:
Abdomen
Adult
Biopsy
Case reports
Disease Management
endocrine cancer
endocrinology
Gastrointestinal Agents - therapeutic use
Glucagon
Glucose
Growth hormones
Humans
Hypoglycemia
Hypoglycemia - diagnosis
Hypoglycemia - etiology
Hypoglycemia - therapy
Insulin
Insulin - biosynthesis
Liver
Lymphatic system
Male
Metastasis
Neuroendocrine tumors
Neuroendocrine Tumors - complications
Neuroendocrine Tumors - diagnosis
Neuroendocrine Tumors - metabolism
Octreotide - therapeutic use
oncology
Pancreatic Neoplasms - complications
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - metabolism
Pathology
Patient admissions
Peptides
Positron-Emission Tomography
Rare Disease
Serotonin
Serotonin - biosynthesis
Tomography, X-Ray Computed
Urine
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Description
Summary:A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin. Management involved a multimodal approach in an attempt to reduce tumour burden and achieve euglycaemia, which proved to be a significant challenge in the face of refractory hypoglycaemia despite the administration of multiple prohyperglycaemic agents in combination. Unfortunately, given the burden of metastatic disease and multiple medical complications that ensued, the patient passed away. This case highlights the clinical history of a NET co-secreting serotonin and insulin, the use of combination therapy in the treatment of refractory hypoglycaemia in a metastatic insulin-producing tumour and emerging therapeutic modalities in the treatment of these rare malignancies.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-236659