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Non-islet cell tumour hypoglycaemia (NICH) (Pathophysiology (Secrete high…
Non-islet cell tumour
hypoglycaemia (NICH)
Definition
Tumour of cells within the pancreas
other than pancreatic islet cells
Pathophysiology
Secrete high levels of IGF-II, resulting
suppression of IGF-I and GH
IGF-II agonises insulin receptors
causing hypoglycaemia
Often fibrosarcomas and mesotheliomas
Clinical
presentation
Hypoglycaemia
Weight loss
Malaise/fatigue
Diagnosis
Investigations
Bedside
Obs, ECG
Bloods
FBC (anaemia), U+Es, LFTs (deranged if liver mets),
glucose (low), lipids, clotting, bone profile (mets)
Imaging
Abdo USS - mass
Abdo CT + biopsy - diagnosis, staging
Examination
General: pallor, cachexia
Abdo: ?palpable mass
History
PC/HPC: hypo episodes, malaise, weight loss
PMH: other cancer
DH: regular meds, allergies
FH: NICH, other cancers
SH: smoking, alcohol, occupation
Management
Initial ABCDE
Definitive
Medical
Glucose infusions
Surgical
Debulking
Conservative
Monitoring
Endocrine referral