Renal cell carcinoma has previously been associated with hypoglycaemia in the setting of non-islet cell tumours, caused by a paraneoplastic phenomenon relating to the production of insulin-like growth factor type II. We present a case of recurrent clear cell renal cell carcinoma, leading to an insulin-mediated paraneoplastic phenomenon causing severe recurrent hypoglycaemia. Hypoglycaemina was managed successfully using diazoxide therapy, in conjunction with pazopanib and radiotherapy to reduce tumour burden.
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