From Hypoglycaemia to Haemorrhage - A Case of Giant Pleural Solitary Fibrous Tumour With Doege–Potter Syndrome

Sep 29, 2026

Uploaded by hdkawk

Doege–Potter Syndrome (DPS) is a rare paraneoplastic cause of hypoglycaemia linked to solitary fibrous tumours (SFTs) that ectopically secrete insulin-like growth factor II (IGF-II). A 76-year-old man presented with recurrent severe hypoglycaemia and significant weight loss. Imaging confirmed a giant right pleurally-based SFT, and management used intravenous dextrose and glucagon until surgical resection. Post-operative glucose normalized, while histopathology showed a spindle cell SFT without malignant features.

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Introduction

Case Report

Respirology Case Reports CASE REPORT OPEN ACCESS From Hypoglycaemia to Haemorrhage: A Case of Giant Pleural Solitary Fibrous Tumour With Doege–Potter Syndrome Michael Xie1 | Ronan O'Donnabhain2 | Zemin Cao2 | Jazmin Eckhaus2 | Phillip Parente2,3 | Alan Wong4 | David Holcdorf2 | Victor Duong1,2 1Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia | 2Epworth HealthCare, Melbourne, Victoria, Australia | 3Eastern Health Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia | 4Melbourne Pathology, Melbourne, Victoria, Australia Correspondence: Victor Duong ([victor.duong@live.com.au](victor.duong@live.com.au)) Received: 14 September 2025 | Revised: 5 November 2025 | Accepted: 16 November 2025 Associate Editor: Sita Andarini Keywords: Doege–Potter syndrome (DPS) | non-diabetic hypoglycaemia | solitary fibrous tumours (SFT) ABSTRACT Doege–Potter Syndrome (DPS) is a rare paraneoplastic cause of hypoglycaemia, arising from solitary fibrous tumours (SFTs) that ectopically secrete insulin-like growth factor II (IGF-II) . We report a case of DPS in a 76-year-old man presenting with recurrent severe hypoglycaemia. Biochemistry investigations revealed hypoglycaemia with suppressed insulin, C-peptide and beta-hydroxybutyrate levels. Magnetic resonance imaging (MRI) confirmed a giant (205 × 190 × 169mm) right pleurally-based SFT. Hypoglycaemia was managed with intravenous dextrose infusion and glucagon until surgical resection via thoracotomy. A massive transfusion protocol was activated for intra-operative bleeding. Histopathology confirmed a spindle cell SFT without malignant features. Post-operative blood glucose levels normalised, and the patient was discharged without complication. This case highlights the diagnostic challenges of DPS, the potential to maintain pre-operative normoglycaemia without glucocorticoid therapy and the importance of recognising tumour vascularity to guide pre-operative planning and reduce bleeding risk. 1 | Introduction Solitary fibrous tumours (SFTs) are rare mesenchymal tumours with an incidence of 1 per 1,000,000 persons per year [1] . The median age is 50–60, with the majority of cases arising from serosal membranes—predominantly the dura of the meninges (40% of all cases) . Extra-meningeal sites include the abdominal cavity (31% of extra-meningeal sites), limbs (29%) and pleura (22%) [2] . Giant SFT is generally accepted as SFT over 15 cm in diameter or occupying at least 40% of the hemithorax [3] . Most SFTs are highly vascularised, well-defined masses with variable potential for metastasis. Two paraneoplastic syndromes associated with SFTs include hypertrophic osteoarthropathy, involved in less than 10% of cases and hypoglycaemia in less than 5% of cases [4] . Paraneoplastic hypoglycaemia in SFTs, otherwise known as Doege–Potter syndrome (DPS), was named after Karl Doege and Roy Potter in 1930 after they described the first case of fibrous tumour-associated hypoglycaemia. DPS occurs due to the excessive ectopic secretion of an unprocessed high molecular weight form of insulin-like growth factor II (IGF-II), known as big-IGF-II [4] . It remains a rare condition with approximately 76 reported cases in the literature. Diagnosis is a combination of characteristic biochemistry (reduced insulin/C-peptide/proinsulin/beta-hydroxybutyrate), imaging and adequate exclusion This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology. Respirology Case Reports, 2026; 14:e70423 1 of 4 [https://doi.org/10.1002/rcr2.70423](https://doi.or

FAQs

What causes Doege–Potter syndrome in solitary fibrous tumours?

It is caused by ectopic secretion of an unprocessed high molecular weight form of insulin-like growth factor II (big-IGF-II) by the tumour, leading to hypoglycaemia.

How was the patient’s hypoglycaemia managed before surgery?

Hypoglycaemia was treated with intravenous dextrose infusion and glucagon, with blood glucose maintained using dextrose infusions and injections.

What key imaging and pathology findings supported the final diagnosis?

Magnetic resonance imaging confirmed a giant right pleurally-based SFT, and histopathology showed a spindle cell SFT without malignant features.

Sep 29, 2026

Uploaded by hdkawk