Glucocorticoids And Cornstarch Therapy For Non–Islet Cell Tumor Hypoglycemia: A Case Report

ABSTRACT Objective: We present a case of severe hypoglycemia in a patient with recurrent solitary fibrous tumor or non–islet cell tumor, maintained successfully in a euglycemic state with a combination of glucocorticoids and oral intake of uncooked cornstarch. Methods: Case report and literature review. Results: An 80-year-old Caucasian female with a history of solitary fibrous tumor of the lung treated with left lower lobectomy in 2009 had a recurrence in 2015 with a retroperitoneal tumor mass. She presented to our hospital with a syncopal episode and capillary blood glucose of 18 mg/dL. Routine laboratory studies were unrevealing. Fasting insulin-like growth factor 1 (IGF-1) was 228 ng/mL (normal range, 54 to 205 ng/mL), insulin-like growth factor 2 (IGF-2) was 541 ng/mL (normal range, 333 to 967 ng/mL), and the IGF-2:IGF-1 ratio was 2.3 (normal, <3.8). Large amounts of infused glucose barely maintained glycemia, and a trial of octreotide failed. Therefore, she was begun on uncooked cornstarch and prednisone daily. On this regimen, her glucose infusion could be discontinued and she was able to maintain a capillary blood glucose between 80 and 120 mg/dL. Conclusion: Due to our patient's extensive tumor burden and metastasis, supportive management, rather than surgery or chemotherapy, was the only option. Uncooked cornstarch can be taken at bedtime to compensate for the absence of glycogen breakdown due to its slow digestibility. Here, we demonstrate the successful management of hypoglycemia due to an unresectable non–islet cell tumor using uncooked cornstarch along with a relatively low dose of a glucocorticoid. Abbreviations: IGF = insulin-like growth factor; NICTH = non-islet cell tumor hypoglycemia