Abstract Introduction Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome in which a tumor secretes high molecular weight IGF-II, causing hypoglycemia. It is most frequently associated with solitary fibrous tumors (SFTs). SFTs are rare mesenchymal neoplasms that most commonly arise in the thoracic cavity but may occur at various extrapleural sites. When SFTs are complicated by hypoglycemia due to IGF-2 secretion, the condition is termed Doege–Potter syndrome. Clinical Case A 50-year-old man presented with recurrent episodes of daytime fatigue, hunger, and sugar cravings, in addition to nocturnal hypoglycemia requiring awakening every two hours to eat, often accompanied by profuse sweating. Home glucose monitoring confirmed hypoglycemia during symptomatic episodes. He had no significant past medical, surgical, or family history, and no history of substance abuse or chronic medication use. Concurrently, he reported persistent cough and exertional dyspnea, for which he was evaluated in the pulmonology clinic. Initial laboratory investigations were unremarkable. A supervised 72-hour fasting test confirmed hypoglycemia. IGF-1 levels were also measured, but IGF-2 test was unavailable locally. Biochemical results are summarized in Table 1, demonstrating hypoinsulinemic hypoglycemia. Chest computed tomography, performed for respiratory complaints, revealed a well-circumscribed pulmonary mass (image1). Histopathological examination confirmed a solitary fibrous tumor. Taken together, the biochemical results and pathology established a diagnosis of NICTH. Following the diagnosis of NICTH, the patient was stabilized with prednisolone 20 mg twice daily for one week, which improved his hypoglycemia. He then underwent surgical excision of the pulmonary solitary fibrous tumor. Postoperatively, hypoglycemic episodes resolved completely. At follow-up, the patient remained asymptomatic. Conclusion This case highlights the importance of considering Doege–Potter syndrome in otherwise healthy individuals with unexplained fasting or nocturnal hypoglycemia, as early diagnosis and definitive surgical management can be curative. Conflict of Interest Statement The authors declare no conflict of interest regarding this case report. No external funding was received for this work.Figure 1:Chest CT showing a large pulmonary solitary fibrous tumorContrast-enhanced CT of the chest demonstrating a well-circumscribed, heterogenous mass in the right hemithorax measuring approximately 12.7 × 12.0 cm Table 1:Relevant Biochemical FindingsLaboratory evaluation demonstrating hypoglycemia with suppressed insulin and C-peptide levels, negative sulfonylurea screen, low-normal IGF-1, and absence of insulin autoantibodies.
Annabi et al. (Thu,) studied this question.