Non-islet Cell Tumour Hypoglycaemia (NICTH) in Malignant Mesothelioma: Case Report

Non-islet cell tumour hypoglycaemia (NICTH) is an uncommon but important clinical condition. It can occur in a setting of known malignancy. Here, we report the case of a 56-year-old, non-diabetic, female patient with unresectable malignant pleural mesothelioma who presented with unexplained recurrent hypoglycaemia. Surreptitious use of insulin or other hypoglycaemic agents were ruled out. Investigations revealed markedly suppressed insulin-like growth factor-I, normal insulin-like growth factor-II and elevated "big"-insulin-like growth factor-II, supporting the diagnosis of NICTH. Plasma growth hormone concentration was low. Initial treatments using prednisone alone, as well as the subsequent addition of diazoxide, were unsuccessful in maintaining euglycaemia. A combination of dexamethasone and recombinant human growth hormone was used successfully to ameliorate the hypoglycaemic episodes. We herein describe an uncommon clinical manifestation of malignant mesothelioma and provide an overview of the pathophysiology of this syndrome, as well as explore a different treatment regimen as reported in the literature.