Introduction
Tumor-induced hypoglycemia (TIH) is rare and is almost due to excessive secretion of insulin by the tumor. However, TIH has been recently associated with the non islet-cell tumor hypoglycemia (NICTH) syndrome1. The underlying mechanism of hypoglycemia is production of incompletely processed insulin-like growth factor 2 (IGF-2).
Although the actual prevalence is not known, NICTH occurs in patients with solid tumors of mesenchymal or epithelial origin. For epithelial tumors, hepatocellular carcinoma (HCC) is the most frequent2. Rarely, NICTH has been observed as the initial manifestation of HCC3.
We present a patient who presented with severe hypoglycemia and was diagnosed with advanced HCC producing IGF2.