Case presentation An 81-year-old male with stage IV pancreatic ductal adenocarcinoma (PDAC) and liver metastases, undergoing chemotherapy, presented to the emergency department with worsening fatigue. Although his appearance was unwell, he remained conscious and maintained stable vital signs.
Physical examination Abdominal distention without focal neurological abnormalities Laboratory findings Hemoglobin: 9.2 g/dL Aspartate aminotransferase (AST): 62 U/L Alkaline phosphate: 463 U/L Glucose: 32 mg/dL Medical history No history of diabetes No use of insulin, sulfonylureas, or other hypoglycemic medications Initial management Hypoglycemia persisted despite repeated intravenous 50 % dextrose 50% boluses The patient was subsequently admitted to the intensive care unit. Endocrine evaluation Fasting insulin: < 1 mIU/mL) C-peptide: 0.1 ng/mL Insulin autoantibody: Negative Cortisol stimulation…
