Recombinant Human GH in Managing Refractory Hypoglycemia in a Young Patient With Embryonal Rhabdomyosarcoma

Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome associated with various malignancies, mediated by the overproduction of IGF-2. We describe a 24-year-old male with metastatic embryonal rhabdomyosarcoma who presented with severe symptomatic hypoglycemia. Workup confirmed suppressed insulin and ketone levels, with an IGF-2/IGF-1 ratio of 3.6 (<3). Hypoglycemia was initially managed with corticosteroids and dextrose-containing fluids without success. Since surgical debulking was not feasible due to tumor burden, recombinant human GH (rhGH) was considered. Somatropin was initiated at 1 mg daily and uptitrated to 2 mg daily over 2 days, resulting in resolution of hypoglycemia with progressive tapering of dextrose-containing fluids and steroid doses. He was discharged on rhGH 2.7 mg daily with no further hypoglycemic episodes. This case highlights the challenges of NICTH, emphasizing the need for individualized treatment strategies. While the IGF-2/IGF-1 ratio did not meet the classic threshold (>10), other laboratory testing was suggestive of a non-insulin, IGF-2-mediated pathway. The use of rhGH for NICTH is not fully understood; however, it may be an important tool in preventing hypoglycemia in patients with nonresectable malignancies.