Non-islet cell tumor hypoglycemia (NICTH) in pediatric patients is an uncommon phenomenon often presenting with neuroglycopenic symptoms with further workup identifying a mass. Renal solitary fibrous tumors in pediatric patients as the etiology of this paraneoplastic syndrome is exceedingly rare. A 10-year-old female presented with neuroglycopenic symptoms and hypoglycemia that was refractory to oral glucose. After correction of hypoglycemia with a dextrose 50% (D50) bolus and maintenance dextrose 10% normal saline (D10NS) infusion further workup with computed tomography identified a large 15 cm right renal mass without evidence of metastatic disease. Insulin-like growth factor-1 and 2 levels were found to be low. The patient underwent en bloc resection of the mass and kidney which was uncomplicated. Pathology was consistent with a solitary fibrous tumor without extracapsular invasion. Post-operatively, the patient was weaned off of dextrose infusions and returned to normoglycemia on a regular diet within twoh days. She underwent adjuvant chemotherapy with vincristine, doxorubicin, and cyclophosphamide. At 3-month follow up, the patient continues to be normoglycemic without evidence of metastasis or local recurrence. Renal solitary fibrous tumors should be included in the differential diagnosis of children who develop unexplained refractory hypoglycemia.
Harvey et al. (Wed,) studied this question.