{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T22:05:21Z","timestamp":1764540321953,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,9,30]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin. Management involved a multimodal approach in an attempt to reduce tumour burden and achieve euglycaemia, which proved to be a significant challenge in the face of refractory hypoglycaemia despite the administration of multiple prohyperglycaemic agents in combination. Unfortunately, given the burden of metastatic disease and multiple medical complications that ensued, the patient passed away. This case highlights the clinical history of a NET co-secreting serotonin and insulin, the use of combination therapy in the treatment of refractory hypoglycaemia in a metastatic insulin-producing tumour and emerging therapeutic modalities in the treatment of these rare malignancies.<\/jats:p>","DOI":"10.1136\/bcr-2020-236659","type":"journal-article","created":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T16:35:42Z","timestamp":1604939742000},"page":"e236659","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin"],"prefix":"10.1136","volume":"13","author":[{"given":"Justin S","family":"Bhullar","sequence":"first","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3124-3692","authenticated-orcid":false,"given":"Joseph MWS","family":"Leung","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed S","family":"Almehthel","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"2025082622592963000_13.11.e236659.1","first-page":"140097","article-title":"Prolonged life-threatening hypoglycaemia following dose escalation of octreotide LAR in a patient with malignant polysecreting pancreatic neuroendocrine tumour","volume":"2015","author":"Abell","year":"2016","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"2025082622592963000_13.11.e236659.2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/cen.13364","article-title":"Incidence and prognostic value of serotonin secretion in pancreatic neuroendocrine tumours","volume":"87","author":"Zandee","year":"2017","journal-title":"Clin Endocrinol"},{"key":"2025082622592963000_13.11.e236659.3","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2011.011068"},{"key":"2025082622592963000_13.11.e236659.4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.86.5.2227"},{"key":"2025082622592963000_13.11.e236659.5","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19840715)54:2<319::AID-CNCR2820540224>3.0.CO;2-S"},{"key":"2025082622592963000_13.11.e236659.6","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/cen.13528","article-title":"Multidisciplinary management of refractory insulinomas","volume":"88","author":"Brown","year":"2018","journal-title":"Clin Endocrinol"},{"key":"2025082622592963000_13.11.e236659.7","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-1101"},{"key":"2025082622592963000_13.11.e236659.8","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181ee7be2"},{"key":"2025082622592963000_13.11.e236659.9","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1563"},{"key":"2025082622592963000_13.11.e236659.10","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-09-1010"},{"key":"2025082622592963000_13.11.e236659.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1607427"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-236659","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:59:37Z","timestamp":1756274377000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-236659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":11,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,9]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/bcr-2020-236659"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-236659","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}