Doege–Potter syndrome caused by a solitary fibrous tumor arising from the greater omentum: a case report

Doege-Potter syndrome is a rare paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) caused by the excessive production of insulin-like growth factor-II (IGF-II), which occurs in less than 5% of solitary fibrous tumors (SFT). SFTs most commonly arise from the pleura, whereas primary omental origins are exceedingly rare. We report a case of Doege-Potter syndrome in an 83-year-old woman who presented with recurrent hypoglycemic episodes caused by a large primary omental SFT. Low serum insulin levels during hypoglycemia and normal adrenocortical hormone levels excluded common causes, such as insulinoma and adrenal insufficiency, and imaging findings raised the suspicion of SFT. Open surgical resection was performed, and the hypoglycemic symptoms resolved immediately postoperatively. Histopathological examination confirmed the diagnosis of high-risk SFTs. Western blot analysis of preoperative and postoperative serum samples demonstrated a postoperative reduction in tumor-derived high-molecular-weight IGF-II (big IGF-II), confirming its role as the cause of hypoglycemia. At 6 months postoperatively, no tumor or hypoglycemia recurrence was observed. This case highlights the importance of considering Doege-Potter syndrome in the differential diagnosis of intra-abdominal tumors that present with hypoglycemic episodes.