A rare case of IGF2 mediated hypoglycemia in a diabetic patient – a praneoplastic manifestation of an adrenal tumor
More details
Hide details
Department of Medicine, Tata Main Hospital, Jamshedpur, India
Submission date: 2017-04-22
Acceptance date: 2017-10-14
Online publication date: 2018-06-27
Publication date: 2019-11-18
Corresponding author
Sameer K Mehta   

Tata Main Hospital, Tata Steel Limited C Road West, Northern Town, Bistupur, Jamshedpur 831001 India. Phone: 7763807152.
Pol. Ann. Med. 2018;25(2):237-240
A rare case of persistent hypoglycemia as a paraneoplastic manifestation of an adrenal tumor due to excessive secretion of IGF2 is being reported.

To learn about rare causes of hypoglycemia.

Case study:
Hypoglycemia is most commonly due to antidiabetic drugs. However, it is not always drug induced and it can be observed in other conditions unrelated to diabetes, such as insulinoma, autoimmune disorders, and neoplasia. Herein, we report the case of a rare cause of severe and recurrent hypoglycemia in a 83-year-old diabetic and hypertensive lady who was subsequently diagnosed with adrenal malignancy and hypoglycemia was found to be a paraneoplastic manifestation of the tumor secreting IGF2.

Results and discussion:
Although more than 95% of cases of hypoglycemia are due antidiabetic drugs but there are other rare causes of hypoglycemia – malignancy being the most important in the rare causes of hypoglycemia. Persistent hypoglycemia should arouse a suspicion of a rare cause of hypoglycemia. In our case hypoglycemia was due to excessive secretion of IGF2 by the adrenal tumor. Several such case cases have been reported where hypoglycemia was a paraneoplastic manifestation of the tumor. So, we need to be aware of the rare causes of hypoglycemia as it can lead to the diagnosis of the primary tumor, as has been in our case, and it can also significantly affect the course of the treatment.

IFG2 secreting tumor can be a rare cause of hypoglycemia.

None declared.
Nirantharakumar K, Marshall T, Hodson J, Narendran P, Deeks J, Coleman JJ, et al. Hypoglycemia in non-diabetic in-patients: clinical or criminal?. PLoS ONE. 2012;7(7):e40384.
Nauck MA, Reinecke M, Perren A, et al. Hypoglycemia due to paraneoplastic secretion of insulin-like growth factor-I in a patient with metastasizing large-cell carcinoma of the lung. J Clin Endocrinol Metab. 2007;92(5):1600–1605.
Daughaday WH, Emanuele MA, Brooks MH, Barbato AL, Kapadia M, Rotwein P. Synthesis and secretion of insulin-like growth factor II by a leiomyosarcoma with associated hypoglycemia. N Eng J Med. 1988;319(22):1434–1440.
Bodnar TW, Acevedo MJ, Pietropaolo M. Management of non-islet-cell tumor hypoglycemia: a clinical review. J Clin Endocrinol Metab. 2013;99(3):713–722.
Hunter SJ, Daughaday WH, Callender ME, et al. A case of hepatoma associated with hypoglycaemia and overproduction of IGF-II (E-21): beneficial effects of treatment with growth hormone and intrahepatic adriamycin. Clin Endocrinol. 1994;41(3):397–401.
Tsuro K, Kojima H, Okamoto S, et al. Glucocorticoid therapy ameliorated hypoglycemia in insulin-like growth factor-II-producing solitary fibrous tumor. Int Med. 2006;45(8):525–529.
Teale JD,Wark G. The effectiveness of different treatment options for non-islet cell tumour hypoglycaemia. Clin Endocrinol. 2004;60(4):457–460.
Silveira LF, Bouloux PM, MacColl GS, Camacho-Hubner C, Miraki-Moud F. Growth hormone therapy for non-islet cell tumor hypoglycemia. Am J Med. 2002;113(3):255–257.
Journals System - logo
Scroll to top