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Recurrent Hypoglycaemia in a Diabetic Patient Presented a Gastric Cancer: Think about Paraneoplastic Syndrome

Case Reports in Clinical Medicine 2019年第7期8卷 196-203页

作者： Ruffin Randriamalala Lovasoa Tika mampionona ranaivomanana Andriamiarimbola Irène Rakotoniaina Florine Rafaramino Andry Riel Department of Cancerology and Polyvalent Medicine University Hospital Tuléar Madagascar Cancerology Department University Hospital Antananarivo Madagascar Cancerology Department University Hospital Fianarantsoa Madagascar Laboratory Department University Hospital Tuléar Madagascar Reanimation Department University Hospital Tuléar Madagascar

The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.

关键词： Extrapancreatic Tumors Gastric Carcinoma Hypoglycaemia Paraneoplastic Syndrome

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