Recurrent Hypoglycemia Due to a Massive Abdominal Tumor in a Nonagenarian: A Case Report and Review of the Literature

Objective: Unusual clinical course Background: Whipple's triad is a rare condition that prompts urgent investigation. A rare cause of such a clinical presentation is excess production of insulin-like growth factor 2 (IGF-2) from a solitary fibrous tumor. Case Report: A 94-year-old man presented to the hospital following episodes of confusion, gait disturbance, and multiple falls secondary to hypoglycemia. His initial blood glucose was 45 mg/dL, with normalization to 144 mg/dL after administration of 1 ampule of glucose in the field. By the time the patient arrived at our facility, his blood glucose had fallen to 75 mg/dL, and then fell further to 38 mg/dL. He had no preceding history of hypoglycemia and led an active lifestyle. His medical history was relatively unremarkable with the exception of a large but asymptomatic solitary fibrous tumor previously diagnosed, being managed conservatively. A physical examination demonstrated a large, left-sided, nontender abdominal tumor. Computed tomography demonstrated a very large well-defined, complex mass in the left upper quadrant of the abdomen. Hypoglycemic episodes occurred frequently, and reliably ensued with fasting. Hypoglycemia proved refractory to conservative strategies, and surgical intervention was recommended. Despite challenges due to the tumor's characteristics, the mass was successfully resected and normoglycemia was achieved within 24 hours. Conclusions: Solitary fibrous tumors may rarely present with hypoglycemia refractory to medical therapy. We present the first reported case of a nonagenarian patient with hypoglycemia secondary to ectopic production of IGF-2 from a solitary fibrous tumor managed with surgical resection.