title: Non-islet cell tumor-induced hypoglycemia: a report of five cases and brief review of the literature.
abstract: We describe the clinical presentation, diagnostic and management issues in five cases of non-islet cell tumor hypoglycemia (NICTH), diagnosed at a tertiary care institute over a period of 15 years. The clinical, laboratory, and histopathological findings of these patients along with diagnostic utility of IGF2:IGF1 ratio are discussed. The mean age of presentation was 52 years, with a male predominance (3:2). Three patients presented with recurrent episodes of fasting hypoglycemia and it was detected in other two patients during hospitalization. Two patients had acromegaloid features that regressed following treatment. One patient had hypokalemia. Low levels of insulin, C-peptide, GH, and IGF1 were invariably found in all. The IGF2 level was elevated in only one patient; however, IGF2:IGF1 ratio was more than 10 in four of the five patients. The mean tumor size was 16.4 cm and mean weight was 3.6 kg. Four patients had mesenchymal tumors and one had epithelial tumor. NICTH is a rare cause of hypoglycemia. Hypoinsulinemic hypoglycemia with low IGF1 and IGF2:IGF1 ratio more than 10 is suggestive of this entity.
  
  
  CONCLUSIONS
  NICTH should be considered in patients presenting with tumor of mesenchymal origin and hypoglycemia.Hypoinsulinemic hypoglycemia with low IGF1 is a strong biochemical evidence of NICTH.IGF2:IGF1 ratio of more than 10 is a complementary investigation in the absence of an assay facility for IGF2.
authors.affiliation: Department of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Dutta
authors.affiliation: Department of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Department of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Yashpal
authors.initials: Y
authors.lastname: Gogate
authors.affiliation: Department of Histopathology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Uma
authors.initials: U
authors.lastname: Nahar
authors.affiliation: Department of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Viral N
authors.initials: VN
authors.lastname: Shah
authors.affiliation: Department of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singla
authors.affiliation: Department of Radiodiagnosis Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: N
authors.initials: N
authors.lastname: Khandelwal
authors.affiliation: Department of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, 160012 India.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali