Fibrous Mesothelioma with Hypoglycemic Psychosis and Coma

The syndrome of large nonpancreatic tumors with hypoglycemia has been recognized as a clinical entity. A spindletype of cell predominates in these tumors; they are located in the thorax or abdomen and generally attain a massive size before symptoms of hypoglycemia appear. The patient here described, when admitted to the hospital, had a large abdominal mass; he was maniacal and later became comatose. Intravenous administration of glucose caused striking temporary improvement. Surgical extirpation of a large retroperitoneal mesothelioma was followed by a lasting stabilization of the blood sugar and glucose tolerance within normal limits. Biologic assay of tumor tissue and plasma in this case did not reveal any increased insulin-like activity.