PARANEOPLASTIC HYPOGLYCEMIA SECONDARY TO A SOLITARY FIBROUS TUMOR: A CASE OF DOEGE-POTTER SYNDROME

Paraneoplastic syndromes result from tumor-secreted hormones or immune cross-reactivity, with paraneoplastic hypoglycemia—specifically non-islet cell tumor hypoglycemia (NICTH) induced by “big” insulin-like growth factor-2 (IGF-2)—representing a rare but critical clinical entity. We report the case of a 63-year-old woman presenting with acute confusion and dysarthria. Initial evaluation revealed profound hypoglycemia (33 mg/dL), which was managed with intravenous glucose, leading to rapid clinical recovery. Biochemical analysis during the episode showed appropriately suppressed insulin (0.30 µIU/mL) and C-peptide (0.21 ng/mL) levels, along with normal cortisol, suggesting an extrapancreatic source. Radiographic imaging via chest X-ray and CT scan identified a 14.8 cm heterogeneously enhancing mass in the left lower lung. Histopathological examination and positive CD34 staining confirmed a solitary fibrous tumor. The constellation of a solitary fibrous tumor and IGF-2-mediated hypoglycemia confirmed a diagnosis of Doege-Potter Syndrome. This case highlights the importance of considering non-islet cell tumor hypoglycemia in patients presenting with refractory low blood glucose and a localized mass.