Diagnosis and Management of Nonislet Cell Tumor Hypoglycemia

Tumor-associated hypoglycemia is a well-documented but rare cause of hypoglycemia. There are 2 major causes: fasting hypoglycemia associated with unregulated insulin production by islet-cell tumors ("insulinomas") and, more commonly, noninsulin-mediated fasting hypoglycemia induced by extrapancreatic tumors, so-called nonislet cell tumor hypoglycemia (NICTH). Although surgical debulking is the treatment of choice, many cases involve elderly patients with incurable tumors, in which freedom from tumor-related hypoglycemia is a key factor determining quality of life (and short-term survival). Therefore, a combination of dietetic and specific medical treatments, including glucocorticoids, human recombinant growth hormone, glucagon, and somatostatin analogs, alone or in combination, remains the mainstay of treatment of majority of the patients. We present our experience in the management of NICTH in 6 patients with the various modalities of medical treatment.